Provider Demographics
NPI:1326693466
Name:DITTLINGER, BRIANNA NICOLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:DITTLINGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NICOLE
Other - Last Name:ZIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:WELCHES
Mailing Address - State:OR
Mailing Address - Zip Code:97067-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23561 E WILDWOOD AVE # USPS372
Practice Address - Street 2:
Practice Address - City:WELCHES
Practice Address - State:OR
Practice Address - Zip Code:97067-9784
Practice Address - Country:US
Practice Address - Phone:971-293-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190160001041C0700X
ORL81371041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical