Healthcare Provider Details

I. General information

NPI: 1144946401
Provider Name (Legal Business Name): MISSING PIECE AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 E 12TH AVE
SPOKANE VALLEY WA
99206-5456
US

IV. Provider business mailing address

12005 E 12TH AVE
SPOKANE VALLEY WA
99206-5456
US

V. Phone/Fax

Practice location:
  • Phone: 509-795-0777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RENEE PETERSON
Title or Position: OWNER, BCBA
Credential: BCBA, LBA
Phone: 509-795-0777