MEDICARE: MS. MONICA KOLB ANDREWS MSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L5162	OR
2	1041C0700X	Clinical Social Worker	LW60003992	WA

General Provider Information

NPI Number	:	1316312432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA KOLB ANDREWS MSS

Provider Business Mailing Address
First Line	:	5817 N PRINCETON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5133
Country	:	US
Telephone Number	:	503-621-7055
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 N PRINCETON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5133
Country	:	US
Telephone Number	:	503-621-7055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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