Healthcare Provider Details

I. General information

NPI: 1619647955
Provider Name (Legal Business Name): NATASHA MINNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7346 NE SANDY BLVD
PORTLAND OR
97213-5775
US

IV. Provider business mailing address

18008 NE 47TH AVE
VANCOUVER WA
98686-1885
US

V. Phone/Fax

Practice location:
  • Phone: 503-746-3373
  • Fax:
Mailing address:
  • Phone: 909-747-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: