Healthcare Provider Details

I. General information

NPI: 1770496952
Provider Name (Legal Business Name): MONIKA HERTOG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 N WERTH BLVD
NEWBERG OR
97132-7500
US

IV. Provider business mailing address

32825 SE 42ND ST
FALL CITY WA
98024-8745
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-2521
  • Fax:
Mailing address:
  • Phone: 503-554-2521
  • Fax: 503-554-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: