Individual provider Active NPI

Sarah Joan Gordon, L.I.C.S.W

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1881945103
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7156 Issued in OR
Practice address
1027 E Burnside Street
Portland, OR 97216-1280
Phone
(503) 239-8400
Fax
(503) 239-8406
NPI assigned
Sep 26, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 19093 MN
Behavior Analyst 103K00000X 19093 MN
Clinical Social Worker 1041C0700X 19093 MN
Clinical Social Worker 1041C0700X 7156 OR Primary

Addresses

Primary practice location

1027 E Burnside Street
Portland, OR 97216-1280

Mailing address

1027 E. Burnside St
Portland, OR 97216
Phone (503) 239-8400

Other identifiers 1

IdentifierTypeStateIssuer
A097725000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240415003090 OR Practitioner - Clinical Social Worker 1456790104 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19093MNMDClinical Social Worker
7156ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Willamette Health & Wellness LLC CurrentSince Feb 21, 2024 Accepting new patients
Coda, Inc. Mental Health PastSince Aug 13, 2019 Accepting new patients
Coda, Inc. PastSince Feb 9, 2020 Accepting new patients

Locations

700 NE Multnomah St
Ste 275
Portland, OR 97232
Phone (503) 729-1380

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1348617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486598400000",
    "number": "1881945103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E. BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 E BURNSIDE STREET",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972161280",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SARAH",
        "middle_name": "JOAN",
        "credential": "L.I.C.S.W",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-26",
        "last_updated": "2017-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "19093",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MN",
            "license": "19093",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19093",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "7156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A097725000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.