Individual
JASEN THAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BHS
Contact information
Practice address
11410 NE 122ND WAY, KIRKLAND, WA 98034-6945
(425) 650-4005
Mailing address
24000 VAN RY BLVD APT 404, MOUNTLAKE TERRACE, WA 98043-5464
(304) 690-1688
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/09/2025
Last updated
09/09/2025
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