Individual
PHILIP BROESAMLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
60 MALLORY LN., SHADY COVE, OR 97539
(541) 878-2658
Mailing address
PO BOX 323, SHADY COVE, OR 97539
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/08/2015
Last updated
04/08/2015
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