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General NPI Number Information
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NPI Number | 1376493197
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Entity Type | Individual
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Provider Name | SADIE LYN ROUSSEL
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Gender | Female
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 7238 N BURLINGTON AVE
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City | PORTLAND
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State | OR
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Zip | 97203-4817
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Country | US
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Telephone | 971-238-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 5224 NE 43RD AVE
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City | PORTLAND
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State | OR
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Zip | 97218-1514
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Country | US
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Telephone | 971-238-1946
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Fax |
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | BAP-FA-10257024
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License Number State | OR
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