Healthcare Provider Details

I. General information

NPI: 1710701156
Provider Name (Legal Business Name): CARLI SAWYER VANDENHOUTEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLI RENE SAWYER-VANDENHOUTEN

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 SE 25TH ST
GRESHAM OR
97080-9301
US

IV. Provider business mailing address

PO BOX 796
GRESHAM OR
97030-0184
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-3977
  • Fax:
Mailing address:
  • Phone: 503-516-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10032604
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: