Healthcare Provider Details

I. General information

NPI: 1275993727
Provider Name (Legal Business Name): DAWN M EK CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10763 SW GREENBURG RD STE 100
TIGARD OR
97223-5492
US

IV. Provider business mailing address

10763 SW GREENBURG RD STE 100
TIGARD OR
97223-5492
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-8159
  • Fax:
Mailing address:
  • Phone: 503-684-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16-01-02
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: