Provider Demographics
NPI:1801612791
Name:COTTER, AMY GERALDINE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:GERALDINE
Last Name:COTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 NW BETHANY CT STE 116
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6009
Mailing Address - Country:US
Mailing Address - Phone:503-430-8539
Mailing Address - Fax:503-747-4210
Practice Address - Street 1:16500 NW BETHANY CT STE 116
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6009
Practice Address - Country:US
Practice Address - Phone:503-430-8539
Practice Address - Fax:503-747-4210
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1-24-77563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst