Healthcare Provider Details

I. General information

NPI: 1497671978
Provider Name (Legal Business Name): IAN VAN NIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 3RD ST STE 201
BLAINE WA
98230-4057
US

IV. Provider business mailing address

955 3RD ST STE 201
BLAINE WA
98230-4057
US

V. Phone/Fax

Practice location:
  • Phone: 206-751-6155
  • Fax:
Mailing address:
  • Phone: 206-751-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70140126
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: