Healthcare Provider Details

I. General information

NPI: 1306778717
Provider Name (Legal Business Name): BRANDY KNUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SW GREENBURG RD STE 235
TIGARD OR
97223-5473
US

IV. Provider business mailing address

9900 SW GREENBURG RD STE 235
TIGARD OR
97223-5473
US

V. Phone/Fax

Practice location:
  • Phone: 503-308-8016
  • Fax:
Mailing address:
  • Phone: 503-308-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9424
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: