| Pacific Northwest Behavior, Llc | |
|
1209 W 1st Ave Spokane WA 99201-4101 | |
| (509) 995-3388 | |
| (509) 321-4350 |
| Full Name | Pacific Northwest Behavior, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1209 W 1st Ave, Spokane, Washington |
| Authorized Official Name and Position | Kourtney Lea Kennedy (OWNER) |
| Authorized Official Contact | 5099953388 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Northwest Behavior, Llc Po Box 8344 Spokane WA 99203-0344 Ph: (509) 995-3388 | Pacific Northwest Behavior, Llc 1209 W 1st Ave Spokane WA 99201-4101 Ph: (509) 995-3388 |
| NPI Number | 1275020547 |
|---|---|
| Provider Enumeration Date | 04/22/2018 |
| Last Update Date | 01/24/2024 |
| Certification Date | 01/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275020547 | NPI | - | NPPES |
| 2100815 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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