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NPI Code Detail

MEDICARE: JAMES MATTHEW SARDO PH.D.

MEDICARE: JAMES MATTHEW SARDO PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2332WA

General Provider Information

NPI Number : 1366432643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MATTHEW SARDO PH.D.
Provider Business Mailing Address
First Line : 3403 SE 176TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-3592
Country : US
Telephone Number : 360-696-4061
Fax Number : 360-737-1419
Provider Business Practice Location Address
First Line : 3710 SW US VETERANS HOSPITAL RD
Second Line : V3-SATP
City : PORTLAND
State : OR
Zip : 97239-2964
Country : US
Telephone Number : 360-696-4061
Fax Number : 360-737-1419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/08/2007

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