Provider Demographics
NPI:1215404181
Name:BRODRICK, SCOTT ANDREW ROBERT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW ROBERT
Last Name:BRODRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2506
Mailing Address - Country:US
Mailing Address - Phone:509-477-4392
Mailing Address - Fax:509-477-3615
Practice Address - Street 1:312 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2506
Practice Address - Country:US
Practice Address - Phone:509-477-4392
Practice Address - Fax:509-477-3615
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health