Provider Demographics
NPI:1760861884
Name:STOLLBERG, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:STOLLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 NW SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1643
Mailing Address - Country:US
Mailing Address - Phone:503-964-2634
Mailing Address - Fax:
Practice Address - Street 1:447 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4103
Practice Address - Country:US
Practice Address - Phone:503-640-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health