Provider Demographics
NPI:1326653965
Name:VEGDAHL, SONJA BERNICE (PHD LICSW)
Entity Type:Individual
Prefix:DR
First Name:SONJA
Middle Name:BERNICE
Last Name:VEGDAHL
Suffix:
Gender:F
Credentials:PHD LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2704
Mailing Address - Country:US
Mailing Address - Phone:360-904-5012
Mailing Address - Fax:
Practice Address - Street 1:809 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2704
Practice Address - Country:US
Practice Address - Phone:360-904-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610596601041C0700X
ORL22001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical