Healthcare Provider Details

I. General information

NPI: 1376197418
Provider Name (Legal Business Name): OREGON BLACK DOULA ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 NE MARTIN LUTHER KING JR BLVD APT 222
PORTLAND OR
97212-3189
US

IV. Provider business mailing address

10350 N VANCOUVER WAY # 1120
PORTLAND OR
97217-7530
US

V. Phone/Fax

Practice location:
  • Phone: 503-793-0977
  • Fax: 503-961-1946
Mailing address:
  • Phone: 503-793-0977
  • Fax: 503-961-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. JONA Y ALLEN
Title or Position: OWNER/ MEMBER
Credential:
Phone: 503-793-0977