Provider Demographics
NPI:1851684807
Name:SLOAN, ROBERT R (MA CADC 1)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MA CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:1312 SW WASHINGTON STREET
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3007
Mailing Address - Country:US
Mailing Address - Phone:503-535-1151
Mailing Address - Fax:503-535-1191
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2327
Practice Address - Country:US
Practice Address - Phone:503-535-1151
Practice Address - Fax:503-535-1191
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-12-45101YA0400X
ORC3388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional