Healthcare Provider Details

I. General information

NPI: 1386565778
Provider Name (Legal Business Name): SARAH EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 SW SKYLINE BLVD STE 104
PORTLAND OR
97221-2547
US

IV. Provider business mailing address

5223 NE 31ST AVE
PORTLAND OR
97211-6911
US

V. Phone/Fax

Practice location:
  • Phone: 971-203-2326
  • Fax:
Mailing address:
  • Phone: 503-580-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: