Provider Demographics
NPI:1174630834
Name:STRAUB, SONJA BRIGITTE (PHD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:BRIGITTE
Last Name:STRAUB
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 1:3150 SE MANNTHEY RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-9765
Mailing Address - Country:US
Mailing Address - Phone:503-727-2456
Mailing Address - Fax:503-727-2456
Practice Address - Street 1:325 NW 21ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1179
Practice Address - Country:US
Practice Address - Phone:503-727-2456
Practice Address - Fax:503-727-2456
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist