Tietjen, Jeffrey Carl

Tietjen, Jeffrey Carl is an individual health care provider with primary practice located at 340 Ne Maple St , Pullman WA 99163-4120. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as his primary health care specialty. Tietjen, Jeffrey Carl can be contacted via phone (509) 334-1133.

Contact Information

Primary practice address
340 Ne Maple St Pullman WA 99163-4120
Phone: (509) 334-1133
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X

Profile Details

NPI number 1295402477
LBN Legal business name Tietjen, Jeffrey Carl
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2021
Last updated Aug 25th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295402477 NPPES
Washington MEDICAID 7104177

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