Provider Demographics
NPI:1982887782
Name:GANDALF, DAWN (CADC III)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:GANDALF
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 COBURG RD
Mailing Address - Street 2:BLDG.4 SUITE 2
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4982
Mailing Address - Country:US
Mailing Address - Phone:541-684-3988
Mailing Address - Fax:541-686-2279
Practice Address - Street 1:1755 COBURG RD
Practice Address - Street 2:BLDG.4 SUITE 2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4982
Practice Address - Country:US
Practice Address - Phone:541-684-3988
Practice Address - Fax:541-686-2279
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-R-07101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)