Provider Demographics
NPI:1609343730
Name:BRADLEY, BRIANNA (LICSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE # 4292
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:206-274-9325
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE # 4292
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:206-274-9325
Practice Address - Fax:888-384-2554
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610879301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty