Provider Demographics
NPI:1700275583
Name:SANDAGE, TIA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:SANDAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:AMREIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:971 SW WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5651
Mailing Address - Country:US
Mailing Address - Phone:503-640-5297
Mailing Address - Fax:503-640-5780
Practice Address - Street 1:971 SW WALNUT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5651
Practice Address - Country:US
Practice Address - Phone:503-640-5297
Practice Address - Fax:503-640-5780
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist