Provider Demographics
NPI:1972636678
Name:MCCOOL, BRENDA MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MARIE
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:SLAWINOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:13110 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8468
Mailing Address - Country:US
Mailing Address - Phone:503-698-5866
Mailing Address - Fax:503-698-5787
Practice Address - Street 1:13110 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8468
Practice Address - Country:US
Practice Address - Phone:503-698-5866
Practice Address - Fax:503-698-5787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1382175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath