NPIMap

Organization Active NPI

Sundstrom Clinical Services LLC

  • Psychologist
  • West Linn, OR
National Provider Identifier
1669508412
Registry record updated Jan 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
01229457-2 Issued in OR
Legal business name
SUNDSTROM CLINICAL SERVICES LLC
Practice address
21900 Willamette Dr Ste 202
West Linn, OR 97068-3284
Phone
(503) 653-0631
Fax
(503) 653-1464
NPI assigned
Feb 26, 2007
Last updated
Jan 30, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol Lazrine
Title
Practice Administrator
Phone
(503) 653-0631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 01229457-2 OR Primary

Addresses

Primary practice location

21900 Willamette Dr Ste 202
West Linn, OR 97068-3284

Mailing address

21900 Willamette Dr Ste 202
West Linn, OR 97068-3284
Phone (503) 653-0631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041108000526 OR Part B Supplier - Clinic/Group Practice 7113980467 Receives reassigned benefits from 1 practitioner
Practice locations: West Linn, OR

National Provider Directory

National Provider Directory

Locations

8440 SE Sunnybrook Blvd
Ste 120
Clackamas, OR 97015
Phone (503) 653-0631

21900 Willamette Dr
Ste 202
West Linn, OR 97068
Phone (503) 653-0631

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1669508412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631",
            "fax_number": "503-653-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631",
            "fax_number": "503-653-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDSTROM CLINICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "LAZRINE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "503-653-0631"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "01229457-2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Linn, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.