Provider Demographics
NPI:1982281291
Name:TEDRICK, SARAH JEAN (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:TEDRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13424 SE 169TH AVE # A120
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8744
Mailing Address - Country:US
Mailing Address - Phone:503-960-2817
Mailing Address - Fax:
Practice Address - Street 1:510 NE ROBERTS AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7484
Practice Address - Country:US
Practice Address - Phone:503-300-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health