DR. MICHAEL DAVID BRODEUR (NPI# 1225375165) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225375165 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL DAVID BRODEUR |
| Credential | PSY.D. |
| Practice Address |
1815 Ne Wilson Rd Pullman WA 99164-0001 |
| Mailing Address |
825 Palouse Vw Pullman WA 99163-5261 |
| Practice Telephone | 5093354511 |
| Mailing Telephone | 4014470459 |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2013-01-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PY60297192 | WA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417290180 | Michael Norman Brodeur | Emergency Medicine | 2606 Hospital Blvd, 5 West, Corpus Christi, TX 78405-1804 | 2013-04-01 |
| 1245423938 | Michael Robert Brodeur Jr. | Chiropractor | 268 Highland Ave, Fall River, MA 02720-5402 | 2007-08-25 |
| 1093805202 | Michael Raymond Brodeur | Pharmacist | 106 New Scotland Ave, Albany College of Pharmacy, Albany, NY 12208-3425 | 2006-10-16 |
| Street Address |
1815 NE WILSON RD |
| City | PULLMAN |
| State | WA |
| Zip Code | 99164-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952837494 | Andrew Mutnan | Specialist/Technologist | 1547 Ne Colorado Street, Pullman, WA 99164 | 2017-05-03 |
| 1861866535 | Washington State University | Psychologist | 305 Ne Troy Mall, Pullman, WA 99164 | 2015-11-18 |
| 1174944169 | Cassie Marie Hodgin | Specialist/Technologist | 1455 Colorado St, Bohler Athletic Complex M4, Pullman, WA 99164 | 2013-12-18 |
| 1629364062 | Brenda Kay Deal Bye | Psychiatry & Neurology | Washington State University 1125 Se Washington St, Pullman, WA 99164 | 2011-06-23 |
| 1750914339 | Kalee Kennedy | Specialist/Technologist | Washington State University, 160 Cleveland Hall 1155 College Ave, Pullman, WA 99164 | 2020-02-21 |
| 1942541859 | Abby Myers Howard | Physician Assistant | 1125 Se Washington Street, Po Box 642302, Pullman, WA 99164 | 2013-03-04 |
| 1235490038 | Blake Cooper Corcoran | Family Medicine | 1125 Se Washington St., Pullman, WA 99164 | 2012-06-07 |
| 1417261934 | Kyrsten E Stoops | Family Medicine | 1125 Se Washington St, Pullman, WA 99164 | 2010-07-27 |
| 1104071752 | Pam Spens | Nurse Practitioner | 1125 Se Washington St, Pullman, WA 99164 | 2008-11-24 |
| 1700958493 | Petrina E Gavrilis | Nurse Practitioner | 1125 Se Washington St., Pullman, WA 99164 | 2006-11-15 |
| Find all providers in zip 99164 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629193198 | Laurie J Smith | Psychologist | 1256 Se Bishop Boulevard, Suite M, Pullman, WA 99163-2413 | 2007-03-20 |
| 1023039526 | Jennifer Ann Luboski | Psychologist | 1256 Se Bishop Blvd Ste N, Pullman, WA 99163-5414 | 2006-07-21 |
| 1407808728 | Lennard Zylstra | Psychologist | 252 Brayton Rd, Pullman, WA 99163-8935 | 2006-05-16 |
| 1619956844 | Jessica Leigh Viergutz-cavagnetto | Psychologist | 107 South Grand Avenue, Suite D, Pullman, WA 99163 | 2006-01-16 |
| 1205349990 | Intercare Community Health Network | Psychologist | 5498 109th Ave, Pullman, MI 49450-9631 | 2017-11-16 |
| 1841646882 | Nikki Stypa | Psychologist | 1240 Se Bishop Blvd, Ste Q, Pullman, WA 99163-5439 | 2016-05-09 |
| 1568705960 | Angela Lea Stone | Psychologist | 340 Ne Maple St, Pullman, WA 99163-4120 | 2013-04-03 |
| 1215125562 | Len D Mccoy Psy D | Psychologist | 1260 Se Bishop Blvd, Suite B, Pullman, WA 99163-5451 | 2007-10-11 |
| 1891992293 | Independent Psychologists | Psychologist | 1256 Se Bishop Boulevard, Suite M, Pullman, WA 99163-2413 | 2007-06-28 |
| 1780732073 | Douglas W Lane | Psychologist | 1205 Se Professional Mall Blvd, Suite 113, Pullman, WA 99163-5423 | 2007-01-05 |
| Find all providers in PULLMAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.