Provider Demographics
NPI:1821224601
Name:ROTT, MARC ALAN
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ALAN
Last Name:ROTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19673 TONI CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7992
Mailing Address - Country:US
Mailing Address - Phone:503-679-5019
Mailing Address - Fax:
Practice Address - Street 1:307 E 2ND ST STE 130
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3076
Practice Address - Country:US
Practice Address - Phone:503-679-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker