Basic Information
| Provider Information | |||||||||
| NPI: | 1629151493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASSIRER | ||||||||
| FirstName: | ISHARA | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 NW GREENBRIAR PL | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034359707 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 565 UNION ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033166770 | ||||||||
| FaxNumber: | 5035850212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | C1874 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.