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NPI Code Detail

MEDICARE: DRAWBRIDGES EMDR

MEDICARE: DRAWBRIDGES EMDR
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
1251S00000XCommunity/Behavioral Health Agency180-006657IL
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1568853059
Entity Type Code : Organization
Provider Name (Legal Business Name) : DRAWBRIDGES EMDR
Provider Business Mailing Address
First Line : 15446 STEPHANIE CT
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3182
Country : US
Telephone Number : 503-479-5474
Fax Number : 847-907-0078
Provider Business Practice Location Address
First Line : 15446 STEPHANIE CT
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3182
Country : US
Telephone Number : 503-479-5474
Fax Number : 847-907-0078
Authorized Official
Title or Position : OWNER, SENIOR COUNSELOR
Name : ERIC JON BRUEMMER
Credential : MS
Telephone Number : 503-479-5474
Provider Enumeration Date : 02/05/2015
Last Update Date : 01/24/2020

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