Provider Demographics
NPI:1376370346
Name:BOTWINICK, MONICA ANN
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:BOTWINICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16555 SW 134TH TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1832
Mailing Address - Country:US
Mailing Address - Phone:541-680-1947
Mailing Address - Fax:
Practice Address - Street 1:4055 SW GARDEN HOME RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3664
Practice Address - Country:US
Practice Address - Phone:503-766-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health