Provider Demographics
NPI:1689246779
Name:SANGIOVANNI, KAREN LORAINE (CADC II)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LORAINE
Last Name:SANGIOVANNI
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LORAINE
Other - Last Name:SANGIOVANNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8549
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1313
Mailing Address - Country:US
Mailing Address - Phone:541-687-1110
Mailing Address - Fax:541-683-9061
Practice Address - Street 1:1050 PRICE RD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7314
Practice Address - Country:US
Practice Address - Phone:541-928-9681
Practice Address - Fax:541-928-5990
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-03-46101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)