MEDICARE: AUBREY DOBRKOVSKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C4112	OR

General Provider Information

NPI Number	:	1205907714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY DOBRKOVSKY

Provider Business Mailing Address
First Line	:	2001 COMMERCIAL ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-949-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 COMMERCIAL ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-949-7431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/21/2022

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