Individual
SYLVIA SUSANNE SORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17420 CROWNVIEW DR, GLADSTONE, OR 97027-1107
(503) 656-1204
Mailing address
17420 CROWNVIEW DR, GLADSTONE, OR 97027-1107
(503) 656-1204
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
519100
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519100
—
OR
Enumeration date
10/15/2014
Last updated
10/15/2014
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