Provider Demographics
NPI:1639677131
Name:DOBEK, CASSIDY (CPM LDM)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:DOBEK
Suffix:
Gender:F
Credentials:CPM LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 NE WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4628
Mailing Address - Country:US
Mailing Address - Phone:802-349-7077
Mailing Address - Fax:
Practice Address - Street 1:9002 NE WEBSTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4628
Practice Address - Country:US
Practice Address - Phone:802-349-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1018728176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife