Provider Demographics
NPI:1578985594
Name:BRADE, VIVIAN ANN (MSPA)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ANN
Last Name:BRADE
Suffix:
Gender:F
Credentials:MSPA
Other - Prefix:MS
Other - First Name:VIVIAN
Other - Middle Name:ANN
Other - Last Name:HOLMQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPA
Mailing Address - Street 1:4407 116TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8568
Mailing Address - Country:US
Mailing Address - Phone:360-657-6657
Mailing Address - Fax:360-657-6658
Practice Address - Street 1:4407 116TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8568
Practice Address - Country:US
Practice Address - Phone:360-657-6657
Practice Address - Fax:360-657-6658
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60432316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist