Provider Demographics
NPI:1275678161
Name:ALLIS, SYDNEY JANE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:JANE
Last Name:ALLIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 NW NAITO PKWY APT A23
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3720
Mailing Address - Country:US
Mailing Address - Phone:503-432-5902
Mailing Address - Fax:
Practice Address - Street 1:2410 SE 121ST AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4066
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health