Provider Demographics
NPI:1831377696
Name:MARTIN, DAWN LYNNEA (PHD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:LYNNEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:LYNNEA
Other - Last Name:KONRAD-MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:MAIL STOP NCRAR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-1402
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:MAIL STOP NCRAR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-721-1402
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22467231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist