Provider Demographics
NPI:1710041744
Name:WILBORN, SANDRA (MS, BA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WILBORN
Suffix:
Gender:F
Credentials:MS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 SE 15TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3856
Mailing Address - Country:US
Mailing Address - Phone:503-927-8159
Mailing Address - Fax:
Practice Address - Street 1:2130 SW 5TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4938
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:503-552-6208
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered372600000XNursing Service Related ProvidersAdult Companion