Active NPI
Donavan Trae Wesley
- Behavior Technician
- Dupont, WA
National Provider Identifier
1699588657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 61583604
- Practice address
- 1570 Wilmington Dr Ste 220
Dupont, WA 98327-8773 - Phone
- (206) 453-4882
- NPI assigned
- Jan 31, 2025
- 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 | 61583604 | WA | Primary |
Addresses
Primary practice location
1570 Wilmington Dr Ste 220
Dupont, WA 98327-8773
Mailing address
7612 19TH LN SE Apt 102
Lacey, WA 98503-5304
Phone (253) 617-8676
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 |
|---|---|---|---|
| 61583604 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1699588657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7612 19TH LN SE APT 102",
"city": "LACEY",
"state": "WA",
"postal_code": "985035304",
"telephone_number": "253-617-8676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 WILMINGTON DR STE 220",
"city": "DUPONT",
"state": "WA",
"postal_code": "983278773",
"telephone_number": "206-453-4882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WESLEY",
"first_name": "DONAVAN",
"middle_name": "TRAE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-31",
"last_updated": "2025-01-31",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "61583604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dupont, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.