Healthcare Provider Details

I. General information

NPI: 1235815473
Provider Name (Legal Business Name): BRYANA MADISON CODDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST #505
TACOMA WA
98409
US

IV. Provider business mailing address

2580 MANN AVE APT C
JOINT BASE LEWIS MCCHORD WA
98433
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 518-593-5728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: