Healthcare Provider Details

I. General information

NPI: 1598928335
Provider Name (Legal Business Name): JACQULENE BRANDT B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 HWY 99 N
EUGENE OR
97402-2008
US

IV. Provider business mailing address

825 WASHINGTON ST APT 27
EUGENE OR
97401-2887
US

V. Phone/Fax

Practice location:
  • Phone: 541-689-7156
  • Fax:
Mailing address:
  • Phone: 541-556-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: