Individual
BROCK O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
651 STRANDER BLVD STE 105, TUKWILA, WA 98188-2914
(206) 313-8840
Mailing address
18207 1ST AVE S APT C4, NORMANDY PARK, WA 98148-1851
(206) 403-0053
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB60888664
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111524501
—
WA
Enumeration date
03/07/2020
Last updated
03/07/2020
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