Provider Demographics
NPI:1992991772
Name:BRANDENBURG, CHELSEA EASTON (MED)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:EASTON
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 N 89TH LOOP
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-6753
Mailing Address - Country:US
Mailing Address - Phone:541-239-3558
Mailing Address - Fax:
Practice Address - Street 1:6750 N 89TH LOOP
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-6753
Practice Address - Country:US
Practice Address - Phone:541-239-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500737326Medicaid