Healthcare Provider Details

I. General information

NPI: 1871337071
Provider Name (Legal Business Name): MONET-ROSE SCOTT RICHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR SUITE 300
GRESHAM OR
97030
US

IV. Provider business mailing address

11035 NE SANDY BLVD
PORTLAND OR
97220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4200
  • Fax:
Mailing address:
  • Phone: 503-258-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA15686
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: