Healthcare Provider Details

I. General information

NPI: 1427643758
Provider Name (Legal Business Name): CHANHTHANALY SAYADETH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHANHTHANALY SAYADETH MSW

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FORTH PLAIN BLVD
VANCOUVER WA
98661
US

IV. Provider business mailing address

2036 NE DEKUM ST
PORTLAND OR
97211-5315
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8246
  • Fax:
Mailing address:
  • Phone: 503-935-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61270789
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: