MEDICARE: MS. SARA ANN BOOTH MSW

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	1041C0700X	Clinical Social Worker	6020	OR

General Provider Information

NPI Number	:	1659550937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA ANN BOOTH MSW

Provider Business Mailing Address
First Line	:	12530 SE OATFIELD RD APT 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-6963
Country	:	US
Telephone Number	:	503-348-2986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 SE JEFFERSON ST STE 205
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7691
Country	:	US
Telephone Number	:	503-348-2986
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/11/2025

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