Provider Demographics
NPI:1508256272
Name:OSMUS, DAHNA (RN, LCSW)
Entity Type:Individual
Prefix:
First Name:DAHNA
Middle Name:
Last Name:OSMUS
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1856
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-1856
Mailing Address - Country:US
Mailing Address - Phone:541-951-3690
Mailing Address - Fax:
Practice Address - Street 1:14 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7332
Practice Address - Country:US
Practice Address - Phone:541-951-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL37261041C0700X
OR093000207163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health