Provider Demographics
NPI:1487786224
Name:DRAKE, BRENDA LYNN (AAS, BC-HIS)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LYNN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:AAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 N MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9557
Mailing Address - Country:US
Mailing Address - Phone:509-465-0370
Mailing Address - Fax:
Practice Address - Street 1:1912 N DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2271
Practice Address - Country:US
Practice Address - Phone:509-328-6731
Practice Address - Fax:509-328-4327
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00003416237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058991Medicaid
WA07047OtherHEARPO
WA0209481OtherLABOR AND INDUSTRIES