Individual
MR. BRADLEY JUSTIN FOSNOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9901 NE 7TH AVE STE C116, VANCOUVER, WA 98685-4528
(360) 571-2432
Mailing address
10115 NW LAKESHORE AVE, VANCOUVER, WA 98685-4748
(503) 839-3062
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
WDL242B9213B
WA
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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