Individual
CODY ALAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1003 7TH AVE, KIRKLAND, WA 98033-5779
(142) 565-8301
Mailing address
702 W CASINO RD APT Y205, EVERETT, WA 98204-8101
(253) 258-6908
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2024
Last updated
02/20/2024
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