Healthcare Provider Details

I. General information

NPI: 1578669982
Provider Name (Legal Business Name): BARBARA KAY BRIGHAM L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536NEWINCHESTER ST C
ROSEBURG OR
97470-3265
US

IV. Provider business mailing address

536NEWINCHESTER ST C
ROSEBURG OR
97470-3265
US

V. Phone/Fax

Practice location:
  • Phone: 541-315-6857
  • Fax: 541-496-0456
Mailing address:
  • Phone: 541-315-6857
  • Fax: 541-496-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI5362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: