Provider Demographics
NPI:1376735027
Name:BRANDSTETTER, CORINNA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:LEE
Last Name:BRANDSTETTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18640 NE JAQUITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6635
Mailing Address - Country:US
Mailing Address - Phone:503-964-7642
Mailing Address - Fax:
Practice Address - Street 1:710 E FOOTHILLS DR STE C
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6125
Practice Address - Country:US
Practice Address - Phone:503-964-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical