Provider Demographics
NPI:1114059235
Name:MOWRY, DWIGHT DEAN (PHD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:DEAN
Last Name:MOWRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2134
Mailing Address - Country:US
Mailing Address - Phone:541-889-2932
Mailing Address - Fax:541-889-2955
Practice Address - Street 1:182 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2134
Practice Address - Country:US
Practice Address - Phone:541-889-2932
Practice Address - Fax:541-889-2955
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCGSHMedicare ID - Type UnspecifiedPROVIDER NUMBER