=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619832961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN JAMES MILES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 N VERCLER RD STE 2
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99216-1092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-640-1824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1124 W SPOFFORD AVE APT 1
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99205-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-640-1824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | CBT.CB.70069047
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------