| Doctor Name: | EMILY BROOM |
| NPI Number: | 1063811073 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | L4624 |
| Business Practice Address: | 617 Ne Davis St Mcminnville, OR - 971284716 |
| Business Phone Number: | 5034724020 |
| Business Fax Number: | 5034728630 |
| Mailing Address: | 617 Ne Davis St, MCMINNVILLE |
| State: | OR |
| Postal Code: | 971284716 |
| Phone Number: | 5034724020 |
| Fax Number: | 5034728630 |
| NPI Enumeration Date: | 08/14/2014 |
| NPI Last Update Date: | 08/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | L4624 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |