Provider Demographics
NPI:1699225540
Name:BRACKIN, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRACKIN
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 1:753 SANCTUARY LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2353
Mailing Address - Country:US
Mailing Address - Phone:303-396-8655
Mailing Address - Fax:
Practice Address - Street 1:2224 S FRASER ST
Practice Address - Street 2:UNIT 6
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4531
Practice Address - Country:US
Practice Address - Phone:720-584-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst