Provider Demographics
NPI:1154089324
Name:DURAN-CONRAD, DAWN S M (CADC I/PSS/QMHA-II)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:S M
Last Name:DURAN-CONRAD
Suffix:
Gender:F
Credentials:CADC I/PSS/QMHA-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:211 SE CARUTHERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4502
Practice Address - Country:US
Practice Address - Phone:503-224-1044
Practice Address - Fax:971-260-0355
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112742175T00000X
OR24-QMHA-II-000211101YM0800X
OR21-09-1241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500802130Medicaid
OR500802129Medicaid