Provider Demographics
NPI:1922736719
Name:DREYER-GOLDMAN, IVY (MSW)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:DREYER-GOLDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CLUB RD STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2463
Mailing Address - Country:US
Mailing Address - Phone:541-393-5983
Mailing Address - Fax:
Practice Address - Street 1:66 CLUB RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2463
Practice Address - Country:US
Practice Address - Phone:541-393-5983
Practice Address - Fax:541-726-1465
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA14070101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor