Provider Demographics
NPI:1699002246
Name:FRIEND, MONIKA B (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:B
Last Name:FRIEND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 ANDREA ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-6962
Mailing Address - Country:US
Mailing Address - Phone:503-926-3832
Mailing Address - Fax:
Practice Address - Street 1:8102A SW DURHAM RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7315
Practice Address - Country:US
Practice Address - Phone:503-926-3832
Practice Address - Fax:503-620-6488
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500627841Medicaid