Provider Demographics
NPI:1851316392
Name:O'DONNELL, SALLY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:A
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WILLAMETTE ST
Mailing Address - Street 2:SUITE 208C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2612
Mailing Address - Country:US
Mailing Address - Phone:541-687-5635
Mailing Address - Fax:541-686-3340
Practice Address - Street 1:541 WILLAMETTE ST
Practice Address - Street 2:SUITE 208C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2612
Practice Address - Country:US
Practice Address - Phone:541-687-5635
Practice Address - Fax:541-686-3340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366747OtherBC/BS
PA4413OtherUPMC
PA1366747OtherBC/BS