Provider Demographics
NPI:1407139397
Name:SANDER, LAURA BAKER (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BAKER
Last Name:SANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4675 NW OWYHEE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2731
Mailing Address - Country:US
Mailing Address - Phone:971-533-8112
Mailing Address - Fax:
Practice Address - Street 1:4675 NW OWYHEE CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2731
Practice Address - Country:US
Practice Address - Phone:971-533-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL68661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical