Provider Demographics
NPI:1669799029
Name:BRICKER, REBECCA (CD(CERTIFIED DOULA))
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRICKER
Suffix:
Gender:F
Credentials:CD(CERTIFIED DOULA)
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-1502
Mailing Address - Country:US
Mailing Address - Phone:541-602-0345
Mailing Address - Fax:
Practice Address - Street 1:506 S. 19TH STREET
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370
Practice Address - Country:US
Practice Address - Phone:541-929-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2105374J00000X
ORL-110010163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula