Healthcare Provider Details

I. General information

NPI: 1548194996
Provider Name (Legal Business Name): EMMA ELIZABETH FORTMILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22300 SW BOONES FERRY RD
TUALATIN OR
97062-7373
US

IV. Provider business mailing address

22300 SW BOONES FERRY RD
TUALATIN OR
97062-7373
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-5648
  • Fax:
Mailing address:
  • Phone: 503-431-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: