Healthcare Provider Details

I. General information

NPI: 1295202109
Provider Name (Legal Business Name): BRENNA FUOTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SE SALMON DR
REDMOND OR
97756-8427
US

IV. Provider business mailing address

1444 SW 39TH ST
REDMOND OR
97756-6617
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-5437
  • Fax: 541-923-5142
Mailing address:
  • Phone: 503-860-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number581442
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: