MEDICARE: SADIE LYN ROUSSEL

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
1	247200000X	Other Technician	BAP-FA-10257024	OR

General Provider Information

NPI Number	:	1376493197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADIE LYN ROUSSEL

Provider Business Mailing Address
First Line	:	5224 NE 43RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1514
Country	:	US
Telephone Number	:	971-238-1946
Fax Number	:

Provider Business Practice Location Address
First Line	:	7238 N BURLINGTON AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-4817
Country	:	US
Telephone Number	:	971-238-1946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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Directions to “ SADIE LYN ROUSSEL ” Practice Location

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