Provider Demographics
NPI:1962683011
Name:GRACIE, SAIGE A (CADCI)
Entity Type:Individual
Prefix:
First Name:SAIGE
Middle Name:A
Last Name:GRACIE
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 NE FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3139
Mailing Address - Country:US
Mailing Address - Phone:503-235-3546
Mailing Address - Fax:503-235-3791
Practice Address - Street 1:2545 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3139
Practice Address - Country:US
Practice Address - Phone:503-235-3546
Practice Address - Fax:503-235-3791
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09-12-15101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)