Provider Demographics
NPI:1255660924
Name:CORONADO-SINCLAIR, ELIZABETH A (QMHP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:CORONADO-SINCLAIR
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3722
Mailing Address - Country:US
Mailing Address - Phone:503-588-5828
Mailing Address - Fax:503-588-5803
Practice Address - Street 1:681 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3722
Practice Address - Country:US
Practice Address - Phone:503-588-5828
Practice Address - Fax:503-588-5803
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator