NPI 1134717747

Matt Childs

Practitioner Supports Brokerage Agency North Bend, WA

Practice location

Address: 1315 11th CT SW, North Bend, WA 98045-7989
Phone: (812) 251-6639

Registered specialties

Supports Brokerage Agency Primary

Agencies Taxonomy 251X00000X Licence 1031895 (WA)

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Registry record

NPI: 1134717747
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Jan 2021
Record last updated: 8 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.