Individual
JACOB BRYAN DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9901 NE 7TH AVE STE C116, VANCOUVER, WA 98685-4528
(360) 571-2432
Mailing address
9901 NE 7TH AVE STE C116, VANCOUVER, WA 98685-4528
(360) 571-2432
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
WDL76118D13B
WA
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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