Provider Demographics
NPI:1992987077
Name:EGAN, ALICIA M (BA, CDP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:BA, CDP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:BUDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:410 N 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2721
Mailing Address - Country:US
Mailing Address - Phone:509-406-3552
Mailing Address - Fax:
Practice Address - Street 1:2280 SR 821
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901
Practice Address - Country:US
Practice Address - Phone:509-457-0990
Practice Address - Fax:509-452-1221
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60025719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)