Provider Demographics
NPI:1740925098
Name:REA, SARAH MARIE (CHW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:REA
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60791 IONE GOOSEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:OR
Mailing Address - Zip Code:97843-7410
Mailing Address - Country:US
Mailing Address - Phone:541-519-7975
Mailing Address - Fax:
Practice Address - Street 1:60791 IONE GOOSEBERRY RD
Practice Address - Street 2:
Practice Address - City:IONE
Practice Address - State:OR
Practice Address - Zip Code:97843-7410
Practice Address - Country:US
Practice Address - Phone:541-519-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104484172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker