Provider Demographics
NPI:1689889610
Name:SMITH, SHARON KAY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 RYAN CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4034
Mailing Address - Country:US
Mailing Address - Phone:503-989-1672
Mailing Address - Fax:
Practice Address - Street 1:714B MAIN ST
Practice Address - Street 2:206
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1821
Practice Address - Country:US
Practice Address - Phone:503-989-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical