Individual
LISA BRAUDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
Mailing address
5004 MARIOLA LN, PASCO, WA 99301-8242
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00004024
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL00004024
STATE LICENSE
WA
Enumeration date
09/10/2019
Last updated
09/10/2019
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