Provider Demographics
NPI:1043461205
Name:WILKES, BRENDA JO (BRENDA WILKES, LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JO
Last Name:WILKES
Suffix:
Gender:F
Credentials:BRENDA WILKES, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21210 NW MAUZEY RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9327
Mailing Address - Country:US
Mailing Address - Phone:503-439-9531
Mailing Address - Fax:503-531-3841
Practice Address - Street 1:21210 NW MAUZEY RD.
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-439-9531
Practice Address - Fax:503-531-3841
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL43021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical