Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | MD00039391 | WA |
NPI | 1245208404 |
---|---|
Provider Name | Mr. James William Ethier |
First Address | Wenatchee, WA 98801-2105 |
Second Address | Wenatchee, WA 98801-2105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 01/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8310617 | (05) | WA |
H52121 | (02) | WA |