Healthcare Provider Details

I. General information

NPI: 1093217150
Provider Name (Legal Business Name): DRESDEN TILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN TILLMAN

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N ARGONNE RD STE 204
SPOKANE VALLEY WA
99212-2839
US

IV. Provider business mailing address

300 N ARGONNE RD STE 204
SPOKANE VALLEY WA
99212-2839
US

V. Phone/Fax

Practice location:
  • Phone: 208-699-2595
  • Fax:
Mailing address:
  • Phone: 208-699-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-26054
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: