Provider Demographics
NPI:1811588767
Name:BOTSCH, BRIANNE ROCHELLE
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ROCHELLE
Last Name:BOTSCH
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 1:1134 BARNES AVE SE APT 202
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2589
Mailing Address - Country:US
Mailing Address - Phone:503-602-5100
Mailing Address - Fax:
Practice Address - Street 1:1134 BARNES AVE SE APT 202
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2589
Practice Address - Country:US
Practice Address - Phone:503-602-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program