Provider Demographics
NPI:1710011911
Name:BLUE, SHERI (LCSW,CADC1,LMT)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:LCSW,CADC1,LMT
Other - Prefix:MS
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:LEDEBUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3945 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5241
Mailing Address - Country:US
Mailing Address - Phone:503-917-3226
Mailing Address - Fax:503-386-3016
Practice Address - Street 1:3945 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5241
Practice Address - Country:US
Practice Address - Phone:503-917-3226
Practice Address - Fax:503-386-3016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-12-06101YA0400X
OR5842225700000X
ORL60791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist