Provider Demographics
NPI:1669882031
Name:OTTO, DANA GOSS (LCSW, MPH)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:GOSS
Last Name:OTTO
Suffix:
Gender:F
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 COLLINS WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3459
Mailing Address - Country:US
Mailing Address - Phone:503-675-2830
Mailing Address - Fax:503-675-2852
Practice Address - Street 1:3990 COLLINS WAY STE 202
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3459
Practice Address - Country:US
Practice Address - Phone:503-675-2830
Practice Address - Fax:503-675-2852
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL55361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical