Provider Demographics
NPI:1013194562
Name:CLAYTON, SALLY VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:VICTORIA
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2362
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-2362
Mailing Address - Country:US
Mailing Address - Phone:503-531-3574
Mailing Address - Fax:503-305-5684
Practice Address - Street 1:1070 NW MURRAY RD STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5568
Practice Address - Country:US
Practice Address - Phone:503-531-3574
Practice Address - Fax:503-305-5684
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
223707OtherMHN
804349000OtherREGENCE BC/BS