Onampai Modi Soondarotok, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L11071 Issued in OR

Practice address

2000 NE 42ND Ave # 1004
Portland, OR 97213-1399

Phone

(503) 683-1558

NPI assigned

Mar 22, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1194285411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 NE 42ND AVE # 1004",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131399",
            "telephone_number": "503-683-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 NE 42ND AVE # 1004",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131399",
            "telephone_number": "503-683-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOONDAROTOK",
        "first_name": "ONAMPAI MODI",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Michio Sono
• Shauna Dale Sonoda, RDH
• Edward Weilie Soo, M.D.
• Elizabeth Soo
• Divya Sood, M.D.
• Ilmar Soot, M.D.
• Laurel Curtis Soot, MD
• Scott Johannes Soot, MD
• Jennifer Sopher
• Sophravia Health

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.