Provider Demographics
NPI:1366657462
Name:COBURN-COFFEY, SONDRA DEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:DEE
Last Name:COBURN-COFFEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SONDRA
Other - Middle Name:DEE
Other - Last Name:COBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:528 COTTAGE ST NE
Mailing Address - Street 2:STE 304
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3788
Mailing Address - Country:US
Mailing Address - Phone:503-364-1711
Mailing Address - Fax:503-364-2363
Practice Address - Street 1:528 COTTAGE ST NE
Practice Address - Street 2:STE 304
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3788
Practice Address - Country:US
Practice Address - Phone:503-364-1711
Practice Address - Fax:503-364-2363
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR44961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR164549Medicare Oscar/Certification