Healthcare Provider Details

I. General information

NPI: 1114834371
Provider Name (Legal Business Name): SANDY DORAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA DORAU

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 SW JEFFERSON ST STE 200
PORTLAND OR
97201-7710
US

IV. Provider business mailing address

2786 SW MONTGOMERY DR
PORTLAND OR
97201-1694
US

V. Phone/Fax

Practice location:
  • Phone: 971-266-6910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: