Provider Demographics
NPI:1639641475
Name:BRUDNICKI, ALYSSA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BRUDNICKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3405
Mailing Address - Country:US
Mailing Address - Phone:509-362-1723
Mailing Address - Fax:
Practice Address - Street 1:316 E BOONE AVE
Practice Address - Street 2:SUITE 656
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-362-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607765931041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61140343OtherWASHINGTON STATE