Healthcare Provider Details

I. General information

NPI: 1790649622
Provider Name (Legal Business Name): SAETIA ANAIS GARDNER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 SW 13TH AVE
PORTLAND OR
97205-1703
US

IV. Provider business mailing address

9585 N LOMBARD ST
PORTLAND OR
97203-2109
US

V. Phone/Fax

Practice location:
  • Phone: 503-445-0981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: