Provider Demographics
NPI:1710701156
Name:VANDENHOUTEN, CARLI SAWYER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:SAWYER
Last Name:VANDENHOUTEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CARLI
Other - Middle Name:RENE
Other - Last Name:SAWYER-VANDENHOUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0184
Mailing Address - Country:US
Mailing Address - Phone:503-516-3977
Mailing Address - Fax:
Practice Address - Street 1:875 SE 25TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9301
Practice Address - Country:US
Practice Address - Phone:503-516-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10032604363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health