Healthcare Provider Details

I. General information

NPI: 1831085240
Provider Name (Legal Business Name): AMANDA D BRAKE SWAIC, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GOETHALS DR
RICHLAND WA
99352-3527
US

IV. Provider business mailing address

915 GOETHALS DR
RICHLAND WA
99352-3527
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-2204
  • Fax:
Mailing address:
  • Phone: 509-405-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC70040731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: