Healthcare Provider Details

I. General information

NPI: 1245587815
Provider Name (Legal Business Name): DAWN AYUME IWAMASA MA, CCLS, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 SW BARNES RD #S104
PORTLAND OR
97225-6372
US

IV. Provider business mailing address

8150 SW BARNES RD #S104
PORTLAND OR
97225-6372
US

V. Phone/Fax

Practice location:
  • Phone: 503-707-6388
  • Fax:
Mailing address:
  • Phone: 503-707-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: