Healthcare Provider Details

I. General information

NPI: 1235384173
Provider Name (Legal Business Name): MARGARET BORTZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW DIVISION ST STE 200
GRESHAM OR
97030-5294
US

IV. Provider business mailing address

5873 SW TERWILLIGER BLVD
PORTLAND OR
97239-2860
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4600
  • Fax: 503-667-2580
Mailing address:
  • Phone: 541-255-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: