Provider Demographics
NPI:1770865958
Name:HALE, SHARON SIERRA (MA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SIERRA
Last Name:HALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 SW GREENBURG RD STE 203
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6466
Mailing Address - Country:US
Mailing Address - Phone:503-266-4759
Mailing Address - Fax:
Practice Address - Street 1:11825 SW GREENBURG RD STE 203
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6466
Practice Address - Country:US
Practice Address - Phone:503-266-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WDBCHOtherMEDICARE GROUP
OR164936Medicaid