Provider Demographics
NPI:1194357889
Name:BRAWLEY, EMILY A (SUPD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:BRAWLEY
Suffix:
Gender:F
Credentials:SUPD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:BRAWLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CP61274655
Mailing Address - Street 1:44 E COZZA DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6514
Mailing Address - Country:US
Mailing Address - Phone:509-325-6800
Mailing Address - Fax:
Practice Address - Street 1:1101 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2010
Practice Address - Country:US
Practice Address - Phone:509-324-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60468746376K00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid