Healthcare Provider Details

I. General information

NPI: 1659550937
Provider Name (Legal Business Name): SARA ANN BOOTH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 SE JEFFERSON ST STE 205
MILWAUKIE OR
97222-7691
US

IV. Provider business mailing address

12530 SE OATFIELD RD APT 3
PORTLAND OR
97222-6963
US

V. Phone/Fax

Practice location:
  • Phone: 503-348-2986
  • Fax:
Mailing address:
  • Phone: 503-348-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6020
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: