Healthcare Provider Details

I. General information

NPI: 1154266609
Provider Name (Legal Business Name): FREDDY BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 N HAMILTON ST
SPOKANE WA
99207-2474
US

IV. Provider business mailing address

16265 N LAKESIDE LN
NINE MILE FALLS WA
99026-9455
US

V. Phone/Fax

Practice location:
  • Phone: 866-240-0808
  • Fax: 866-240-0809
Mailing address:
  • Phone: 866-240-0808
  • Fax: 866-240-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: