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General NPI Number Information
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NPI Number | 1942009741
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Entity Type | Individual
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Provider Name | MR. MATT B RENTON
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Gender | Male
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 2310 130TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98005-1799
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Country | US
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Telephone | 425-882-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 8509 GREENWOOD AVE N APT 14
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City | SEATTLE
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State | WA
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Zip | 98103-3629
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Country | US
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Telephone | 206-291-6082
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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 | CB61591880
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License Number State | WA
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