Provider Demographics
NPI:1679453989
Name:DAHL, DANA PSYCHE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:PSYCHE
Last Name:DAHL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 SW VISTA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2609
Mailing Address - Country:US
Mailing Address - Phone:702-994-4795
Mailing Address - Fax:
Practice Address - Street 1:2238 SW VISTA AVE APT 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2609
Practice Address - Country:US
Practice Address - Phone:702-994-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist