BRENT D FISK (NPI# 1124418561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124418561 |
| Entity Type | Individual |
| Full Name | BRENT D FISK |
| Credential | PSYD |
| Practice Address |
1003 Providence Dr Ste 110 Newberg OR 97132-7521 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5035375900 |
| Mailing Telephone | 5032156494 |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2020-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
3093 | OR | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 672 Ne Evans St, Mcminnville, OR 97128 | 5034347505 |
| Street Address |
1003 PROVIDENCE DR STE 110 |
| City | NEWBERG |
| State | OR |
| Zip Code | 97132-7521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013321389 | Jaecelle Guadiz Galeniece | Family Medicine | 1003 Providence Dr Ste 110, Newberg, OR 97132 | 2014-06-16 |
| 1962902130 | Tyler Weiss | Physical Medicine & Rehabilitation | 1003 Providence Dr Ste 110, Newberg, OR 97132-7521 | 2018-02-14 |
| 1073027009 | Ashley Azadeh | Physician Assistant | 1003 Providence Dr Ste 110, Newberg, OR 97132 | 2017-11-29 |
| 1346799632 | Tyrell Jagelski | Physician Assistant | 1003 Providence Dr Ste 110, Newberg, OR 97132-7521 | 2016-09-27 |
| 1467900423 | Makkedah-satori Marielove Emanuel | Physician Assistant | 1003 Providence Dr Ste 110, Newberg, OR 97132-7521 | 2016-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720692007 | Gabrielle Anastasia Humlie | Dietitian, Registered | 109 W 8th St, Newberg, OR 97132 | 2020-09-03 |
| 1093278111 | Viva Wheaton Psyd LLC | Clinical Neuropsychologist | 603 E. Hancock St, Newberg, OR 97132 | 2019-04-08 |
| 1255847554 | John Nguyen | Physical Therapy Assistant | 1900 E. Fulton St., Newberg, OR 97132 | 2017-12-21 |
| 1154835338 | Breanne Embrey | Pharmacist | 1001 Providence Dr., Newberg, OR 97132 | 2017-11-26 |
| 1174063473 | Patricia Roberts | Hearing Instrument Specialist | 1014 B N Springbrook Rd, Newberg, OR 97132 | 2017-03-06 |
| 1477906048 | Dr. Marsha A. Green, L.L.C. | Community/Behavioral Health | 710c Foothills Dr, Ste 104, Newberg, OR 97132 | 2016-07-19 |
| 1760841308 | George Fox University Physical Therapy Community Clinic | Physical Therapist | 501 Villa Road, Newberg, OR 97132 | 2016-02-10 |
| 1790116978 | Nancy Stiehler Thurston | Psychologist | 501 N. Villa Rd., Newberg, OR 97132 | 2013-12-12 |
| 1700138856 | Kristen Z. Grbavac O'halloran | Physical Therapist | 1515 Portland Road, Suite 102, Newberg, OR 97132 | 2012-10-12 |
| 1487931523 | Intercultural Center for Psychology LLC | Psychologist | 710c Foothills Dr, Suite 104, Newberg, OR 97132 | 2011-11-03 |
| Find all providers in zip 97132 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861895237 | Transitions Professional Center | Psychologist | 710 Foothills Dr Ste C, Suite 104, Newberg, OR 97132-6125 | 2014-09-30 |
| 1639593569 | Julia L Terman | Psychologist | 1001 Providence Dr Ste 101, Newberg, OR 97132-7485 | 2014-02-12 |
| 1790116978 | Nancy Stiehler Thurston | Psychologist | 501 N. Villa Rd., Newberg, OR 97132 | 2013-12-12 |
| 1356538847 | Sergiy Barsukov | Psychologist | 502 S Saint Paul Hwy, Newberg, OR 97132-7059 | 2007-09-27 |
| 1922203272 | Marsha Ann Green | Psychologist | 710 E Foothills Dr Ste C, Suite 104, Newberg, OR 97132-6125 | 2007-06-18 |
| 1912090283 | Jennifer Marie Huwe | Psychologist | 470 Villa Rd, Newberg, OR 97132-1858 | 2006-10-01 |
| 1508960758 | Daniel D Carpenter | Psychologist | 501 E 1st St, Newberg, OR 97132-2909 | 2006-09-09 |
| 1912566951 | Jeff Moody, LLC | Psychologist | 307 E 2nd St Ste 250, Newberg, OR 97132-3077 | 2019-06-12 |
| 1447731625 | David Mathew Kays | Psychologist | 1901 Esther St, Newberg, OR 97132-9529 | 2018-08-24 |
| 1447688916 | Jeri Turgesen | Psychologist | 1003 Providence Dr, Suite 101, Newberg, OR 97132-7521 | 2013-10-21 |
| Find all providers in NEWBERG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.