Individual
JAKE SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2222 EAST POWELL BOULEVARD, GRESHAM, OR 97080
(503) 669-4300
Mailing address
15900 SW 76TH AVE, TIGARD, OR 97224-7116
(503) 968-8059
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
ORR305
OR
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
06/26/2023
Last updated
04/06/2026
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