Provider Demographics
NPI:1164943296
Name:GRADY, HANNAH M (RBT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:M
Last Name:GRADY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 BOREN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2713
Mailing Address - Country:US
Mailing Address - Phone:919-610-8844
Mailing Address - Fax:
Practice Address - Street 1:2101 112TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2944
Practice Address - Country:US
Practice Address - Phone:425-748-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician