Provider Demographics
NPI:1134789860
Name:FAUTH, AARON SAMUEL
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:SAMUEL
Last Name:FAUTH
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 1:29610 N MONROE RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-8708
Mailing Address - Country:US
Mailing Address - Phone:509-328-1582
Mailing Address - Fax:
Practice Address - Street 1:528 E SPOKANE FALLS BLVD STE 14
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5081
Practice Address - Country:US
Practice Address - Phone:509-328-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60976885106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician