Provider Demographics
NPI:1073534780
Name:HARDEN, SHERRY LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNN
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NW 3000 STUCKI PLACE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:503-533-9806
Mailing Address - Fax:503-533-9806
Practice Address - Street 1:3000 NW STUCKI PL
Practice Address - Street 2:SUITE 230
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7328
Practice Address - Country:US
Practice Address - Phone:503-533-9806
Practice Address - Fax:503-533-9806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
054123016OtherBLUE CROSS
R111851Medicare ID - Type Unspecified