Individual
MATTHEW SANDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2307 NE 4TH ST APT D203, RENTON, WA 98056-4097
(425) 589-0625
Mailing address
2307 NE 4TH ST APT D203, RENTON, WA 98056-4097
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
WA
106E00000X
Assistant Behavior Analyst
—
WA
106S00000X
Behavior Technician
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111524501
—
WA
Enumeration date
12/18/2018
Last updated
12/18/2018
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