Active NPI
John M Brandon Jr.
- Behavior Technician
- Colville, WA
National Provider Identifier
1659152833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB61492266
- Practice address
- 298 S Main St Ste L
Colville, WA 99114-2404 - Phone
- (808) 681-2718
- NPI assigned
- Oct 12, 2023
- Sex
- Male
- Sole proprietor
- No
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 | CB61492266 | WA | Primary |
Addresses
Primary practice location
298 S Main St Ste L
Colville, WA 99114-2404
Mailing address
298 S Main St Ste L
Colville, WA 99114-2404
Phone (808) 681-2718
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 |
|---|---|---|---|
| CB61492266 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697068800000",
"number": "1659152833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "298 S MAIN ST STE L",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142404",
"telephone_number": "808-681-2718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "298 S MAIN ST STE L",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142404",
"telephone_number": "808-681-2718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDON",
"first_name": "JOHN",
"middle_name": "M",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-12",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB61492266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.