Provider Demographics
NPI:1962889386
Name:LILLIBRIDGE, BREANNA LEE
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:LEE
Last Name:LILLIBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:LEE
Other - Last Name:PARKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9828 30TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3552
Mailing Address - Country:US
Mailing Address - Phone:425-329-5404
Mailing Address - Fax:
Practice Address - Street 1:12040 98TH AVE NE
Practice Address - Street 2:SUITE 204
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4290
Practice Address - Country:US
Practice Address - Phone:425-658-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst