Individual
ETHAN EDDIE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 6TH ST, RAYMOND, WA 98577-2503
(111) 111-1111
Mailing address
320 6TH ST, RAYMOND, WA 98577-2503
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
11/13/2021
Last updated
11/13/2021
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