Provider Demographics
NPI:1316312432
Name:ANDREWS, MONICA KOLB (MSS)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:KOLB
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSS
Mailing Address - Street 1:5817 N PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5133
Mailing Address - Country:US
Mailing Address - Phone:503-621-7055
Mailing Address - Fax:
Practice Address - Street 1:5817 N PRINCETON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5133
Practice Address - Country:US
Practice Address - Phone:503-621-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51621041C0700X
WALW600039921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical