Provider Demographics
NPI:1407600125
Name:BRICE, SHELLEY
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 BROKEN SKILLET WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99173-9746
Mailing Address - Country:US
Mailing Address - Phone:509-263-6076
Mailing Address - Fax:
Practice Address - Street 1:528 E SPOKANE BLVD # 14
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5081
Practice Address - Country:US
Practice Address - Phone:509-328-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician