Provider Demographics
NPI:1285273508
Name:RATZLAFF, BRANDEE KOLENE (MA, LPC)
Entity type:Individual
Prefix:
First Name:BRANDEE
Middle Name:KOLENE
Last Name:RATZLAFF
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 40TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1501
Mailing Address - Country:US
Mailing Address - Phone:503-428-6652
Mailing Address - Fax:
Practice Address - Street 1:2001 COMMERCIAL ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5207
Practice Address - Country:US
Practice Address - Phone:503-370-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional