Provider Demographics
NPI:1588774731
Name:BRAKE, MARI M (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:MARI
Middle Name:M
Last Name:BRAKE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MISS
Other - First Name:MARI
Other - Middle Name:M
Other - Last Name:BARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13420 34TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4625
Mailing Address - Country:US
Mailing Address - Phone:206-987-2644
Mailing Address - Fax:425-451-0214
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S CB
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2644
Practice Address - Fax:425-451-0214
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004126231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8441883Medicaid