Healthcare Provider Details

I. General information

NPI: 1760493852
Provider Name (Legal Business Name): SARAH E NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW 9TH ST
REDMOND OR
97756-2726
US

IV. Provider business mailing address

PO BOX 615
REDMOND OR
97756-0120
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-4778
  • Fax:
Mailing address:
  • Phone: 541-330-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2132
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: