Provider Demographics
NPI:1053483024
Name:BROCKDORF, YULIA (RD LD CD LPC BCADM)
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:BROCKDORF
Suffix:
Gender:F
Credentials:RD LD CD LPC BCADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SW OAK ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3936
Mailing Address - Country:US
Mailing Address - Phone:503-577-5845
Mailing Address - Fax:503-844-6545
Practice Address - Street 1:428 SW OAK ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3936
Practice Address - Country:US
Practice Address - Phone:503-577-5845
Practice Address - Fax:503-844-6545
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4518101YP2500X
OR594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional