Healthcare Provider Details

I. General information

NPI: 1992616791
Provider Name (Legal Business Name): JOSIE RAE BUCHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SW 2ND ST STE A103
BEAVERTON OR
97005-2828
US

IV. Provider business mailing address

7440 SW HERMOSO WAY
PORTLAND OR
97223-7993
US

V. Phone/Fax

Practice location:
  • Phone: 971-712-3628
  • Fax:
Mailing address:
  • Phone: 971-371-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR10272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: