Healthcare Provider Details

I. General information

NPI: 1275006546
Provider Name (Legal Business Name): MONICA PHYLLIS LINDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006-5238
US

IV. Provider business mailing address

26400 NW SAINT HELENS RD SLIP 36
SCAPPOOSE OR
97056-9629
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-3260
  • Fax:
Mailing address:
  • Phone: 503-781-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61561861
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7979
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: