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General NPI Number Information
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NPI Number | 1902378003
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Entity Type | Individual
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Provider Name | BRANDIE LYNNE IMPERIAL LCSW, CADCI
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Gender | Female
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Dates
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Enumeration Date | 12/30/2018
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Last Update Date | 12/30/2018
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Provider Practice Location Address
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Address Line | 10175 SW BARBUR BLVD STE 204B
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City | PORTLAND
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State | OR
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Zip | 97219-5953
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Country | US
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Telephone | 971-666-1290
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Fax | 503-914-1736
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Provider Business Mailing Address
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Address Line | 10175 SW BARBUR BLVD STE 204B
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City | PORTLAND
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State | OR
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Zip | 97219-5953
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Country | US
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Telephone | 971-666-1290
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Fax | 503-914-1736
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L6754
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License Number State | OR
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