Provider Demographics
NPI:1124854583
Name:HASSALL-SANTAELLA, BRONWYN ROSE
Entity type:Individual
Prefix:
First Name:BRONWYN
Middle Name:ROSE
Last Name:HASSALL-SANTAELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SE HAWTHORNE BLVD APT 410
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4180
Mailing Address - Country:US
Mailing Address - Phone:707-672-9328
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1055
Practice Address - Country:US
Practice Address - Phone:360-726-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health