Provider Demographics
NPI:1184787939
Name:MEADOWBROOK, ANN MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:MEADOWBROOK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1052 SW 29TH
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-926-8288
Mailing Address - Fax:541-926-7234
Practice Address - Street 1:1052 SW 29TH
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-926-8288
Practice Address - Fax:541-926-7234
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist