Individual
DONAVAN TRAE WESLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1570 WILMINGTON DR STE 220, DUPONT, WA 98327-8773
(206) 453-4882
Mailing address
7612 19TH LN SE APT 102, LACEY, WA 98503-5304
(253) 617-8676
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
61583604
WA
Other
Enumeration date
01/31/2025
Last updated
01/31/2025
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