Provider Demographics
NPI:1871792580
Name:ROTTERMAN, LOTTIE RENEE (AUD)
Entity type:Individual
Prefix:
First Name:LOTTIE
Middle Name:RENEE
Last Name:ROTTERMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LOTTIE
Other - Middle Name:RENEE
Other - Last Name:POLICAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:24076 SE STARK ST
Practice Address - Street 2:SUITE 230
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3373
Practice Address - Country:US
Practice Address - Phone:503-465-5461
Practice Address - Fax:503-465-5468
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR022302231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1871792580Medicaid
OR234892Medicaid
OR234892Medicaid