Individual
MS. DEIDMA ANN AGEE-BROCKMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6084
Mailing address
PO BOX 579, CORVALLIS, OR 97339-0579
(541) 766-6084
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/31/2007
Last updated
02/09/2010
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