Active NPI
Sage Longbotham
- Clinical Social Worker
- Tigard, OR
National Provider Identifier
1508548660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SC61562531
- Practice address
- 8915 SW Center St
Tigard, OR 97223-6307 - Phone
- (503) 726-3740
- NPI assigned
- Aug 7, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | SC61562531 | OR | Primary |
Addresses
Primary practice location
8915 SW Center St
Tigard, OR 97223-6307
Mailing address
8915 SW Center St
Tigard, OR 97223-6307
Phone (503) 726-3740
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC61562531 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729123200000",
"number": "1508548660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8915 SW CENTER ST",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236307",
"telephone_number": "503-726-3740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8915 SW CENTER ST",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236307",
"telephone_number": "503-726-3740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGBOTHAM",
"first_name": "SAGE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-07",
"last_updated": "2024-10-17",
"certification_date": "2024-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "SC61562531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.