Provider Demographics
NPI:1215444039
Name:DOBSON, AMY JO (MCHES QMHA-I CDCES)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:DOBSON
Suffix:
Gender:F
Credentials:MCHES QMHA-I CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1710
Mailing Address - Country:US
Mailing Address - Phone:541-573-8376
Mailing Address - Fax:541-573-8378
Practice Address - Street 1:348 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1710
Practice Address - Country:US
Practice Address - Phone:541-573-8376
Practice Address - Fax:541-573-8378
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-QMHA-I-02398101YM0800X
226395132700000X
OR172V00000X
1050243136A00000X
12674174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator