Provider Demographics
NPI:1972808723
Name:KUHNHAUSEN, BROOKE ALYSSA (PHD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALYSSA
Last Name:KUHNHAUSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SE LAKE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2129
Mailing Address - Country:US
Mailing Address - Phone:503-786-1711
Mailing Address - Fax:503-786-9919
Practice Address - Street 1:6400 SE LAKE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2129
Practice Address - Country:US
Practice Address - Phone:503-786-1711
Practice Address - Fax:503-786-9919
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2120103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist