Provider Demographics
NPI:1255797510
Name:BROSEMER, STEFANIE (CADCII CRM QMHA)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:
Last Name:BROSEMER
Suffix:
Gender:F
Credentials:CADCII CRM QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3246
Mailing Address - Country:US
Mailing Address - Phone:541-683-1641
Mailing Address - Fax:
Practice Address - Street 1:350 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3246
Practice Address - Country:US
Practice Address - Phone:541-683-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-02
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR09-12-53101YA0400X
OR09-12-53U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor