Provider Demographics
NPI:1316375439
Name:BROOKS, KATHRYN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 NE GREENWOOD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4638
Mailing Address - Country:US
Mailing Address - Phone:541-200-7773
Mailing Address - Fax:541-200-7816
Practice Address - Street 1:354 NE GREENWOOD AVE STE 208
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4638
Practice Address - Country:US
Practice Address - Phone:541-200-7773
Practice Address - Fax:541-200-7816
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1998175F00000X
ORAC185430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist