Basic Information
| Provider Information | |||||||||
| NPI: | 1336627116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADILLA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980335779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256583016 | ||||||||
| FaxNumber: | 4256583017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1003 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980335779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256583016 | ||||||||
| FaxNumber: | 4256583017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2018 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BA60882850 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.