Provider Demographics
NPI:1356523112
Name:BRUMBAUGH, KINDI ELAINE (MSW)
Entity type:Individual
Prefix:MS
First Name:KINDI
Middle Name:ELAINE
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 NE BURNSIDE RD
Mailing Address - Street 2:BUILDING B, SUITE 401
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6722
Mailing Address - Country:US
Mailing Address - Phone:503-666-8832
Mailing Address - Fax:503-669-8641
Practice Address - Street 1:1217 NE BURNSIDE RD
Practice Address - Street 2:BUILDING B, SUITE 401
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6722
Practice Address - Country:US
Practice Address - Phone:503-666-8832
Practice Address - Fax:503-669-8641
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid