Provider Demographics
NPI:1093535171
Name:SMITH, DYLAN PAUL
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 53RD ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-0814
Mailing Address - Country:US
Mailing Address - Phone:253-204-6347
Mailing Address - Fax:
Practice Address - Street 1:8811 S TACOMA WAY STE 204&206
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-559-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician