Provider Demographics
NPI:1619534583
Name:BRAY, EMILY ANNE KAYDE
Entity Type:Individual
Prefix:
First Name:EMILY ANNE
Middle Name:KAYDE
Last Name:BRAY
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 1:11910 PURPLE PENNANT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8669
Mailing Address - Country:US
Mailing Address - Phone:425-583-5443
Mailing Address - Fax:
Practice Address - Street 1:5709 W SUNSET HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-6005
Practice Address - Country:US
Practice Address - Phone:054-420-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-06-15
Deactivation Date:2023-02-16
Deactivation Code:
Reactivation Date:2023-06-09
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
WALL61329272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician