Provider Demographics
NPI:1841054368
Name:SANDRA J KRUSSEL DO PSYCHIATRIST LLC
Entity type:Organization
Organization Name:SANDRA J KRUSSEL DO PSYCHIATRIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KRUSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-276-1297
Mailing Address - Street 1:2250 NW FLANDERS ST STE 306
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5411
Mailing Address - Country:US
Mailing Address - Phone:503-276-1297
Mailing Address - Fax:503-206-0613
Practice Address - Street 1:2250 NW FLANDERS ST STE 306
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5411
Practice Address - Country:US
Practice Address - Phone:503-276-1297
Practice Address - Fax:503-206-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health