1366657462 NPI number — MRS. SONDRA DEE COBURN-COFFEY LCSW

Table of content: MRS. SONDRA DEE COBURN-COFFEY LCSW (NPI 1366657462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366657462 NPI number — MRS. SONDRA DEE COBURN-COFFEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBURN-COFFEY
Provider First Name:
SONDRA
Provider Middle Name:
DEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COBURN
Provider Other First Name:
SONDRA
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366657462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
528 COTTAGE ST NE
Provider Second Line Business Mailing Address:
STE 304
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-3788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-364-1711
Provider Business Mailing Address Fax Number:
503-364-2363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
528 COTTAGE ST NE
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-3788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-364-1711
Provider Business Practice Location Address Fax Number:
503-364-2363
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4496 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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