Individual
JEFFREY CARL TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
340 NE MAPLE ST, PULLMAN, WA 99163-4120
(509) 334-1133
Mailing address
340 NE MAPLE ST, PULLMAN, WA 99163-4120
(509) 334-1133
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7104177
—
WA
Enumeration date
08/25/2021
Last updated
08/25/2021
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