Provider Demographics
NPI:1366819849
Name:SPOONER, SANDRA J (MSW, CSWA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:SPOONER
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CSWA
Mailing Address - Street 1:12901 SE 97TH AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7901
Mailing Address - Country:US
Mailing Address - Phone:503-680-4551
Mailing Address - Fax:503-655-6806
Practice Address - Street 1:12901 SE 97TH AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7901
Practice Address - Country:US
Practice Address - Phone:503-680-4551
Practice Address - Fax:503-655-6806
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA44621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC60593676OtherWASHINGTON STATE DEPARTMENT OF HEALTH
ORA4462OtherCERTIFICATE OF CLINICAL SOCIAL WORK ASSOCIATE