Individual
BRADY MICHAEL SEVERNS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
1118 OAK STREET SE, SALEM, OR 97301
(503) 585-4949
Mailing address
1118 OAK ST SE, SALEM, OR 97301-4019
(503) 585-4949
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122994
—
OR
Enumeration date
08/30/2017
Last updated
07/21/2022
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