Individual
AMANDA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(503) 679-1670
Mailing address
4400 NE HALSEY ST, PORTLAND, OR 97213-1545
(503) 679-1670
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L5524
—
Other
Enumeration date
04/22/2026
Last updated
04/22/2026
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