Provider Demographics
NPI:1366153009
Name:SUTTON, MINDY GISKAAS
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:GISKAAS
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 NW SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2436
Mailing Address - Country:US
Mailing Address - Phone:503-474-7057
Mailing Address - Fax:
Practice Address - Street 1:1308 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2941
Practice Address - Country:US
Practice Address - Phone:971-901-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist