Healthcare Provider Details

I. General information

NPI: 1669376760
Provider Name (Legal Business Name): MARIAH PASSMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N VERCLER RD STE 2
SPOKANE VALLEY WA
99216-1092
US

IV. Provider business mailing address

2214 E EMPIRE AVE
SPOKANE WA
99207-4518
US

V. Phone/Fax

Practice location:
  • Phone: 509-991-7885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberCBT.CB.70186139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: