Individual provider Active NPI

Sandra C Anderson, MSW PHD

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1992765887
Registry record updated Feb 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW61 Issued in OR
Practice address
962 NW Kearney
Suite 106
Portland, OR 97209
Phone
(503) 725-5001
NPI assigned
Mar 24, 2006
Last updated
Feb 18, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW61 OR Primary

Addresses

Primary practice location

962 NW Kearney
Suite 106
Portland, OR 97209

Mailing address

14571 NW Larson Road
Portland, OR 97231-2320
Phone (503) 297-1777

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
I20050314001010 OR Practitioner - Clinical Social Worker 3375598220 Practice locations: Portland, OR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1962 NW Kearney St
Suite 106
Portland, OR 97209-1466
Phone (503) 297-1777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LCSW61ORMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1992765887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14571 NW LARSON ROAD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972312320",
            "telephone_number": "503-297-1777",
            "fax_number": "503-297-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "962 NW KEARNEY",
            "address_2": "SUITE 106",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97209",
            "telephone_number": "503-725-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SANDRA",
        "middle_name": "C",
        "credential": "MSW PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "LCSW61",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.