Healthcare Provider Details

I. General information

NPI: 1043235443
Provider Name (Legal Business Name): BRIDGET ANN BROOKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E BURNSIDE ST
PORTLAND OR
97214-1831
US

IV. Provider business mailing address

9730 SW EAGLE CT
BEAVERTON OR
97008-6610
US

V. Phone/Fax

Practice location:
  • Phone: 503-238-5203
  • Fax: 503-238-5202
Mailing address:
  • Phone: 503-360-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4511
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: