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General NPI Number Information
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NPI Number | 1366432643
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Entity Type | Individual
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Provider Name | JAMES MATTHEW SARDO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD V3-SATP
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 360-696-4061
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Fax | 360-737-1419
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Provider Business Mailing Address
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Address Line | 3403 SE 176TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-3592
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Country | US
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Telephone | 360-696-4061
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Fax | 360-737-1419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2332
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License Number State | WA
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