Provider Demographics
NPI:1427643758
Name:SAYADETH, CHANHTHANALY (MSW)
Entity type:Individual
Prefix:MS
First Name:CHANHTHANALY
Middle Name:
Last Name:SAYADETH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CHANHTHANALY
Other - Middle Name:
Other - Last Name:SAYADETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2036 NE DEKUM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5315
Mailing Address - Country:US
Mailing Address - Phone:503-935-2273
Mailing Address - Fax:
Practice Address - Street 1:1601 E FORTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist