Provider Demographics
NPI:1538679667
Name:BRACKEN, DENICE (RYT200, BSW, MSCN)
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:RYT200, BSW, MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 SW LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3118
Mailing Address - Country:US
Mailing Address - Phone:503-856-4507
Mailing Address - Fax:
Practice Address - Street 1:10512 SW LAUREL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3118
Practice Address - Country:US
Practice Address - Phone:503-856-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach