Healthcare Provider Details

I. General information

NPI: 1992047922
Provider Name (Legal Business Name): CINDY KOTILA OHLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SW MARLOW AVE SUITE 110
PORTLAND OR
97225-5104
US

IV. Provider business mailing address

3525 SE 16TH AVE
PORTLAND OR
97202-2825
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-7979
  • Fax:
Mailing address:
  • Phone: 971-227-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: