Provider Demographics
NPI:1104021682
Name:SANDHU, KARYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19260 SW 65TH AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5710
Mailing Address - Country:US
Mailing Address - Phone:503-691-9777
Mailing Address - Fax:
Practice Address - Street 1:19260 SW 65TH AVE STE 340
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5710
Practice Address - Country:US
Practice Address - Phone:503-691-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-07-04
Deactivation Date:2010-03-29
Deactivation Code:
Reactivation Date:2022-06-27
Provider Licenses
StateLicense IDTaxonomies
ORL34371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical