Provider Demographics
NPI:1336278324
Name:SANDERS, NANCY ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCI
Mailing Address - Street 1:8407 NE HOLLADAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5824
Mailing Address - Country:US
Mailing Address - Phone:503-970-3636
Mailing Address - Fax:
Practice Address - Street 1:1401 NE 68TH AVE
Practice Address - Street 2:SUITE 2152
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4957
Practice Address - Country:US
Practice Address - Phone:503-419-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR08-08-36101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)