Provider Demographics
NPI:1801253315
Name:BRANDENBERGER, FAITH (CADC II)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BRANDENBERGER
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:BRANDENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC II
Mailing Address - Street 1:1669 N NYE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-2257
Mailing Address - Country:US
Mailing Address - Phone:541-574-9570
Mailing Address - Fax:541-574-8857
Practice Address - Street 1:547 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4909
Practice Address - Country:US
Practice Address - Phone:541-574-9570
Practice Address - Fax:541-574-8857
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-11-04174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist