Healthcare Provider Details

I. General information

NPI: 1043136922
Provider Name (Legal Business Name): AUBREY WEIVODA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12014 SE MILL PLAIN BLVD STE 120
VANCOUVER WA
98684-4044
US

IV. Provider business mailing address

3508 NE 109TH AVE APT E4
VANCOUVER WA
98682-7277
US

V. Phone/Fax

Practice location:
  • Phone: 208-297-1405
  • Fax:
Mailing address:
  • Phone: 208-297-1405
  • 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: