Provider Demographics
NPI:1902951338
Name:DAWSON, LILLIE MARGARET (QMHA)
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:MARGARET
Last Name:DAWSON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:LILLIE
Other - Middle Name:MARGARET
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:530 SE 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1930
Mailing Address - Country:US
Mailing Address - Phone:503-257-0447
Mailing Address - Fax:
Practice Address - Street 1:707 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3517
Practice Address - Country:US
Practice Address - Phone:503-222-4906
Practice Address - Fax:503-222-3215
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator