Provider Demographics
NPI:1871791848
Name:BRICKLEY, JEANNE LYNN (LMT)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LYNN
Last Name:BRICKLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 SE OAK GROVE BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2657
Mailing Address - Country:US
Mailing Address - Phone:503-803-3319
Mailing Address - Fax:
Practice Address - Street 1:2080 SE OAK GROVE BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2657
Practice Address - Country:US
Practice Address - Phone:503-803-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist