Healthcare Provider Details

I. General information

NPI: 1538679667
Provider Name (Legal Business Name): DENICE BRACKEN RYT200, BSW, MSCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 NE LINCOLN ST
HILLSBORO OR
97124-3066
US

IV. Provider business mailing address

239 NE LINCOLN ST
HILLSBORO OR
97124-3066
US

V. Phone/Fax

Practice location:
  • Phone: 971-238-4408
  • Fax:
Mailing address:
  • Phone: 971-238-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA18533
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: