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NPI Code Detail

MEDICARE: MR. JONATHAN DOUGLAS DAHL MWS, QMHP

MEDICARE: MR. JONATHAN DOUGLAS DAHL MWS, QMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1356480115
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN DOUGLAS DAHL MWS, QMHP
Provider Business Mailing Address
First Line : 1904 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1146
Country : US
Telephone Number : 503-853-5955
Fax Number :
Provider Business Practice Location Address
First Line : 1904 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1146
Country : US
Telephone Number : 503-853-5955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 09/06/2011

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