MEDICARE: MONTANA SCHROLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	R9329	OR

General Provider Information

NPI Number	:	1083325948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTANA SCHROLL

Provider Business Mailing Address
First Line	:	1750 BLANKENSHIP RD STE 400
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5102
Country	:	US
Telephone Number	:	503-659-5515
Fax Number	:	503-594-8193

Provider Business Practice Location Address
First Line	:	1750 BLANKENSHIP RD STE 400
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5102
Country	:	US
Telephone Number	:	503-659-5515
Fax Number	:	503-594-8193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	01/27/2026

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Directions to “ MONTANA SCHROLL ” Practice Location

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