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General NPI Number Information
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NPI Number | 1356139968
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Entity Type | Individual
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Provider Name | DILLON SANTOS SIEBRECHT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 5280 PENDLETON AVE STE A0021
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98433-1672
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Country | US
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Telephone | 833-747-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 S 30TH ST
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City | TACOMA
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State | WA
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Zip | 98409-3210
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Country | US
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Telephone | 360-621-6083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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