Provider Demographics
NPI:1689286700
Name:DAWSON, ROBERT (QMHA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:QMHA
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 1710
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0516
Mailing Address - Country:US
Mailing Address - Phone:541-516-4087
Mailing Address - Fax:
Practice Address - Street 1:1103 NE ELM ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1664
Practice Address - Country:US
Practice Address - Phone:541-323-5330
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-QMHA-R-0597171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator