Basic Information
| Provider Information | |||||||||
| NPI: | 1801306568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAUENHAUER | ||||||||
| FirstName: | NOLA | ||||||||
| MiddleName: | RANELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 949 MOUNTAIN VIEW LN | ||||||||
| Address2: | |||||||||
| City: | MOLALLA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970387373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035306237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12901 SE 97TH AVE | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970157901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033355875 | ||||||||
| FaxNumber: | 5033355974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2017 | ||||||||
| LastUpdateDate: | 10/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.