Provider Demographics
NPI:1659865780
Name:AWADA, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:AWADA
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 1:1103 S SPOONBILL AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1392
Mailing Address - Country:US
Mailing Address - Phone:208-312-0434
Mailing Address - Fax:
Practice Address - Street 1:1103 S SPOONBILL AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1392
Practice Address - Country:US
Practice Address - Phone:208-312-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2020-11-09
Deactivation Date:2020-04-01
Deactivation Code:
Reactivation Date:2020-08-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician