Provider Demographics
NPI:1639745151
Name:PEONE, BRENDA (SUDP-T)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PEONE
Suffix:
Gender:F
Credentials:SUDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 S GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-9030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:934 S GARFIELD RD
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9030
Practice Address - Country:US
Practice Address - Phone:509-789-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)