Provider Demographics
NPI:1972193159
Name:CABALA, SARAH JEAN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:CABALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW KING AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1401
Mailing Address - Country:US
Mailing Address - Phone:269-615-6436
Mailing Address - Fax:
Practice Address - Street 1:715 SW KING AVE APT 32
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1401
Practice Address - Country:US
Practice Address - Phone:269-615-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN10210367103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst