Provider Demographics
NPI:1427533439
Name:PILGREEN, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:PILGREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 SE RIVER RD APT 318
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-9707
Mailing Address - Country:US
Mailing Address - Phone:541-915-0304
Mailing Address - Fax:
Practice Address - Street 1:811 SE SHERMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4666
Practice Address - Country:US
Practice Address - Phone:971-409-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-AB-10222128106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst