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General NPI Number Information
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NPI Number | 1740125905
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Entity Type | Individual
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Provider Name | NATHAN BRASE CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 755 MISSION ST SE BLDG M
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City | SALEM
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State | OR
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Zip | 97302-6211
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Country | US
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Telephone | 503-814-7962
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Fax |
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Provider Business Mailing Address
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Address Line | 156 FRONT ST NE UNIT 320
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City | SALEM
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State | OR
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Zip | 97301-3479
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17571
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License Number State | OR
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