Provider Demographics
NPI:1184063877
Name:BODEEN, BROOKE A (ND)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:A
Last Name:BODEEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:A
Other - Last Name:HALGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7068
Mailing Address - Country:US
Mailing Address - Phone:503-410-4619
Mailing Address - Fax:
Practice Address - Street 1:465 65TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7068
Practice Address - Country:US
Practice Address - Phone:503-410-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1916175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath