Healthcare Provider Details

I. General information

NPI: 1265257679
Provider Name (Legal Business Name): SARAH NICOLE RAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 PENN LN
OREGON CITY OR
97045-1592
US

IV. Provider business mailing address

1713 PENN LN
OREGON CITY OR
97045-1592
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-7725
  • Fax: 503-655-7720
Mailing address:
  • Phone: 503-655-7725
  • Fax: 503-655-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL30034
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: