Healthcare Provider Details

I. General information

NPI: 1942174115
Provider Name (Legal Business Name): AMY KATHRYN BROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY KATHRYN BROCK

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 NW LABICHE LN STE 120
BEND OR
97703-6748
US

IV. Provider business mailing address

1551 PEARL ST
EUGENE OR
97401-4010
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-9733
  • Fax:
Mailing address:
  • Phone: 541-517-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA18381
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: