Provider Demographics
NPI:1730199100
Name:CRANDLES, SHEILA M (LCSW)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:CRANDLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 N COAST HWY
Mailing Address - Street 2:SEATOWNE SHOPPING CENTER
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2357
Mailing Address - Country:US
Mailing Address - Phone:541-265-5680
Mailing Address - Fax:
Practice Address - Street 1:1626 N COAST HWY
Practice Address - Street 2:SEATOWNE SHOPPING CENTER
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2357
Practice Address - Country:US
Practice Address - Phone:541-265-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR115803Medicare ID - Type UnspecifiedPROVIDER ID NUMBER