Provider Demographics
NPI:1922716315
Name:MILBRODT, MYCHALEA ROSE (QMHA)
Entity type:Individual
Prefix:
First Name:MYCHALEA
Middle Name:ROSE
Last Name:MILBRODT
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:MYCHALEA
Other - Middle Name:ROSE
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836-0469
Mailing Address - Country:US
Mailing Address - Phone:541-676-9161
Mailing Address - Fax:541-676-5662
Practice Address - Street 1:435 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2487
Practice Address - Country:US
Practice Address - Phone:541-564-9390
Practice Address - Fax:541-564-9384
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR1039713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health