Provider Demographics
NPI:1376940841
Name:AUSEN, MILES
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:AUSEN
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 1:10833 SE 200TH ST
Mailing Address - Street 2:G5
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1590
Mailing Address - Country:US
Mailing Address - Phone:206-249-6885
Mailing Address - Fax:
Practice Address - Street 1:10842 SE 190TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7101
Practice Address - Country:US
Practice Address - Phone:206-393-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-29
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst