Provider Demographics
NPI:1497972673
Name:BRADY, REBA M (MA, CDC II)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:MA, CDC II
Other - Prefix:MS
Other - First Name:REBA
Other - Middle Name:M
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CDC II
Mailing Address - Street 1:2151 HEMMER ROAD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-7039
Mailing Address - Fax:907-745-7069
Practice Address - Street 1:2151 HEMMER ROAD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-7039
Practice Address - Fax:907-745-7069
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)