Provider Demographics
NPI:1457063661
Name:IDOW, HUSSEIN DAYOW (CADC-R)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:DAYOW
Last Name:IDOW
Suffix:
Gender:M
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SE 121ST AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-4075
Mailing Address - Country:US
Mailing Address - Phone:503-676-9224
Mailing Address - Fax:
Practice Address - Street 1:2305 SE 121ST AVE APT 16
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4075
Practice Address - Country:US
Practice Address - Phone:503-676-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty