Individual
BROOKE WHITING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
718 N MAIN AVE, GRESHAM, OR 97030-7229
(971) 666-7795
Mailing address
21960 NE CHINOOK WAY APT A, FAIRVIEW, OR 97024-2627
(503) 810-7202
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
E-10238354
OR
247200000X
Other Technician
Primary
E-10238354
OR
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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