Healthcare Provider Details

I. General information

NPI: 1952455644
Provider Name (Legal Business Name): CORDELIA KOLAR QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7621 N PORTSMOUTH AVE
PORTLAND OR
97203-5953
US

IV. Provider business mailing address

4608 NW HARNEY ST
VANCOUVER WA
98663-1730
US

V. Phone/Fax

Practice location:
  • Phone: 503-240-7599
  • Fax: 503-240-8044
Mailing address:
  • Phone: 360-256-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: