Provider Demographics
NPI:1174552434
Name:DREYER, SARAH BRADDY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BRADDY
Last Name:DREYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 NW INNISBROOK PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1907
Mailing Address - Country:US
Mailing Address - Phone:503-617-1687
Mailing Address - Fax:
Practice Address - Street 1:4660 NE BELKNAP CT
Practice Address - Street 2:SUITE 201U
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6467
Practice Address - Country:US
Practice Address - Phone:503-726-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL37291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134465Medicare ID - Type UnspecifiedPART B