Healthcare Provider Details

I. General information

NPI: 1255241774
Provider Name (Legal Business Name): SARAH YUDKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15661 SE 82ND DR
CLACKAMAS OR
97015-9580
US

IV. Provider business mailing address

16212 SE HAROLD AVE
PORTLAND OR
97267-4822
US

V. Phone/Fax

Practice location:
  • Phone: 503-343-9851
  • Fax:
Mailing address:
  • Phone: 503-319-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29707
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: