Most Relevant Information
Provider Data
| NPI Number: | 1003505488 |
| Provider Name: | BRENDA MARIE DEITERING |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/02/2023 |
| Last Updated: | 05/02/2023 |
Provider Practice Location
2375 NW GLISAN ST
PORTLAND
OR
972103420
Practice Location Phone/Fax
| Phone: | 5039637641 |
| Fax: |
Provider Mailing Location
PO BOX 8459
PORTLAND
OR
972078459
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |