Provider Demographics
NPI:1518149376
Name:SAGE, NICHOLE (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NW ISLAND CIRCLE
Mailing Address - Street 2:APT. B1
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:707-301-8875
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST.
Practice Address - Street 2:STE. 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-258-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health