Provider Demographics
NPI:1992765887
Name:ANDERSON, SANDRA C (MSW PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14571 NW LARSON ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-2320
Mailing Address - Country:US
Mailing Address - Phone:503-297-1777
Mailing Address - Fax:503-297-5996
Practice Address - Street 1:962 NW KEARNEY
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-725-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical