Provider Demographics
NPI:1871815480
Name:THEODOROFF, SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:THEODOROFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MELAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5918 NE HOYT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3784
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-1402
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:PORTLAND VAMC, NCRAR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-721-1402
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000552231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist