Healthcare Provider Details

I. General information

NPI: 1356487466
Provider Name (Legal Business Name): SUSAN M. SOTKA LCSW, CADC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21210 NW MAUZEY RD
HILLSBORO OR
97124-9327
US

IV. Provider business mailing address

21210 NW MAUZEY RD
HILLSBORO OR
97124-9327
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9531
  • Fax: 503-531-3841
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3884
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: