Active NPI
Spencer Ward
- Behavior Technician
- Bothell, WA
National Provider Identifier
1619527884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB61007328
- Practice address
- 632 182ND St SE
Bothell, WA 98012-6275 - Phone
- (425) 246-9784
- NPI assigned
- Sep 18, 2019
- Last updated
- May 29, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CB61007328 | WA | Primary |
Addresses
Primary practice location
632 182ND St SE
Bothell, WA 98012-6275
Mailing address
4541 5TH Ave NE
Seattle, WA 98105-4816
Phone (206) 265-9904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CB61007328 | WA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wickler Behavioral Consulting Corp. | Behavior Technician | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590710400000",
"number": "1619527884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4541 5TH AVE NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981054816",
"telephone_number": "206-265-9904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 182ND ST SE",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980126275",
"telephone_number": "425-246-9784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARD",
"first_name": "SPENCER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-18",
"last_updated": "2020-05-29",
"certification_date": "2020-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB61007328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.