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NPI Code Detail

MEDICARE: SELAH JEAN DAMERVILLE

MEDICARE: SELAH JEAN DAMERVILLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1699618579
Entity Type Code : Individual
Provider Name (Legal Business Name) : SELAH JEAN DAMERVILLE
Provider Business Mailing Address
First Line : 500 BUENA VISTA ST
Second Line :
City : CHENEY
State : WA
Zip : 99004-1316
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1720 N HAMILTON ST
Second Line :
City : SPOKANE
State : WA
Zip : 99207-2474
Country : US
Telephone Number : 360-240-0022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ SELAH JEAN DAMERVILLE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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