Healthcare Provider Details

I. General information

NPI: 1306149802
Provider Name (Legal Business Name): JULIE ELLEN BRANDENBURG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

46314 TIMINE WAY
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-240-8751
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-240-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL10782
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: