Provider Demographics
NPI:1235408048
Name:DAWSON, MICHAEL (NP, PMHNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SW MACADAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3827
Mailing Address - Country:US
Mailing Address - Phone:646-342-6446
Mailing Address - Fax:
Practice Address - Street 1:5100 SW MACADAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3827
Practice Address - Country:US
Practice Address - Phone:917-202-5500
Practice Address - Fax:917-202-5555
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340831363LG0600X
OR201806622NP-PP363LG0600X, 363LP0808X
WAAP61029814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology