Healthcare Provider Details

I. General information

NPI: 1508765132
Provider Name (Legal Business Name): HAILEY MC KENZIE SARNACKI CADC, QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 NE BURNSIDE RD
GRESHAM OR
97030-7950
US

IV. Provider business mailing address

7000 SW VARNS ST
TIGARD OR
97223-8006
US

V. Phone/Fax

Practice location:
  • Phone: 971-436-2560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: