Provider Demographics
NPI:1689274821
Name:KUSHNER, SARAH LYNNE (MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:KUSHNER
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 1:111 SW HARRISON ST APT 16C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5382
Mailing Address - Country:US
Mailing Address - Phone:971-330-3793
Mailing Address - Fax:
Practice Address - Street 1:8305 SE MONTEREY AVE STE 111
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7753
Practice Address - Country:US
Practice Address - Phone:971-330-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health