Provider Demographics
NPI:1780215392
Name:BRADY, SUSAN F (MS, CBE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:BRADY
Suffix:
Gender:F
Credentials:MS, CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5408
Mailing Address - Country:US
Mailing Address - Phone:509-630-9501
Mailing Address - Fax:
Practice Address - Street 1:304 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5408
Practice Address - Country:US
Practice Address - Phone:509-630-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN