Provider Demographics
NPI:1730488248
Name:SLOAN, AMBER NICOLE DODGSON (LMT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE DODGSON
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:DODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:16078 SW TUALATIN SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8522
Mailing Address - Country:US
Mailing Address - Phone:503-625-0100
Mailing Address - Fax:503-625-0301
Practice Address - Street 1:9375 SW COMMERCE CIR STE A1
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9630
Practice Address - Country:US
Practice Address - Phone:503-582-9200
Practice Address - Fax:503-682-1487
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist