Provider Demographics
NPI:1417678293
Name:JORDAN-GOODELL, BREANNA ROSE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ROSE
Last Name:JORDAN-GOODELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N COAST HWY STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3165
Mailing Address - Country:US
Mailing Address - Phone:541-272-5048
Mailing Address - Fax:
Practice Address - Street 1:145 N COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3165
Practice Address - Country:US
Practice Address - Phone:541-272-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)