Provider Demographics
NPI:1811528193
Name:SLOAN, ANGELINA STARR (CRM)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:STARR
Last Name:SLOAN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:STARR
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2901 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1831
Mailing Address - Country:US
Mailing Address - Phone:503-238-5203
Mailing Address - Fax:503-238-5202
Practice Address - Street 1:112 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4302
Practice Address - Country:US
Practice Address - Phone:503-722-6277
Practice Address - Fax:503-722-6270
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000004066Medicaid