Healthcare Provider Details

I. General information

NPI: 1609750942
Provider Name (Legal Business Name): CONNOR DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 7TH AVE
SPOKANE WA
99204-2832
US

IV. Provider business mailing address

2217 W QUEEN AVE
SPOKANE WA
99205-5657
US

V. Phone/Fax

Practice location:
  • Phone: 509-850-1080
  • Fax:
Mailing address:
  • Phone: 509-850-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: