Healthcare Provider Details

I. General information

NPI: 1235556077
Provider Name (Legal Business Name): SARA PHILLIPS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE PSYCHOLOGY DEPARTMENT
SALEM OR
97301-2669
US

IV. Provider business mailing address

2600 CENTER ST NE PSYCHOLOGY DEPARTMENT
SALEM OR
97301-2669
US

V. Phone/Fax

Practice location:
  • Phone: 503-947-8001
  • Fax:
Mailing address:
  • Phone: 503-947-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number2249
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2249
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: