Provider Demographics
NPI:1114324902
Name:SPRADLIN, DYLAN ANN (BBH-SWLC-LIC-56957)
Entity Type:Individual
Prefix:MS
First Name:DYLAN
Middle Name:ANN
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:BBH-SWLC-LIC-56957
Other - Prefix:MS
Other - First Name:DYLAN
Other - Middle Name:ANN
Other - Last Name:EMRYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4617 BRISBANE PL
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5503
Mailing Address - Country:US
Mailing Address - Phone:509-387-1083
Mailing Address - Fax:
Practice Address - Street 1:4617 BRISBANE PL
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5503
Practice Address - Country:US
Practice Address - Phone:509-387-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60230055101YM0800X
MTBBH-SWLC-LIC-568571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-SWLC-LIC-56857OtherBOARD OF BEHAVIORAL HEALTH OF MONTANA