Healthcare Provider Details

I. General information

NPI: 1174756571
Provider Name (Legal Business Name): SLAVICA KOJADINOVIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 NW FLANDERS ST STE 201
PORTLAND OR
97210-5410
US

IV. Provider business mailing address

2250 NW FLANDERS ST STE 201
PORTLAND OR
97210-5410
US

V. Phone/Fax

Practice location:
  • Phone: 503-706-0372
  • Fax: 844-293-3937
Mailing address:
  • Phone: 503-706-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5301
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: