Bradley Justin Fosnot

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

WDL242B9213B Issued in WA

Practice address

9901 NE 7TH Ave Ste C116
Vancouver, WA 98685-4528

Phone

(360) 571-2432

NPI assigned

Feb 21, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1861298655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10115 NW LAKESHORE AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986854748",
            "telephone_number": "503-839-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 NE 7TH AVE STE C116",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986854528",
            "telephone_number": "360-571-2432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "996 Royal Marco Way",
            "address_purpose": "LOCATION",
            "city": "Marco Island",
            "state": "FL",
            "postal_code": "341451829",
            "country_code": "US",
            "telephone_number": "469-694-1754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOSNOT",
        "first_name": "BRADLEY",
        "middle_name": "JUSTIN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": "WDL242B9213B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Behavior Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.

Verify at the official NPI Registry.