Provider Demographics
NPI:1891435061
Name:RAUNICH, DAWN L
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:RAUNICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28685 SW ASHLAND LOOP APT 154
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8791
Mailing Address - Country:US
Mailing Address - Phone:503-367-9817
Mailing Address - Fax:
Practice Address - Street 1:28685 SW ASHLAND LOOP APT 154
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8791
Practice Address - Country:US
Practice Address - Phone:503-363-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist