Healthcare Provider Details

I. General information

NPI: 1306591466
Provider Name (Legal Business Name): LYNN OTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N BLAINE ST STE B
NEWBERG OR
97132-2734
US

IV. Provider business mailing address

215 N BLAINE ST STE B
NEWBERG OR
97132-2734
US

V. Phone/Fax

Practice location:
  • Phone: 503-883-8445
  • Fax: 844-940-3035
Mailing address:
  • Phone: 503-883-8445
  • Fax: 844-940-3035

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: