Provider Demographics
NPI:1477161206
Name:BRADY, SARAH (CCMA, CCHW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:CCMA, CCHW
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:CORNELISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCMA, CCHW
Mailing Address - Street 1:1750 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2195
Mailing Address - Country:US
Mailing Address - Phone:541-269-0333
Mailing Address - Fax:
Practice Address - Street 1:1750 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2195
Practice Address - Country:US
Practice Address - Phone:541-269-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWTHW000002218171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator