Provider Demographics
NPI:1720777196
Name:DAWSON, RACHEL ANN (PEER)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PEER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39710 SE PAUL MOORE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6600
Mailing Address - Country:US
Mailing Address - Phone:253-213-9822
Mailing Address - Fax:
Practice Address - Street 1:4101 NE DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4617
Practice Address - Country:US
Practice Address - Phone:506-666-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR107176175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist