Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003337627 |
---|---|
Provider Name | Kelly Peterson |
First Address | Kirkland, WA 98033-6223 |
Second Address | Bellevue, WA 98004-3815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 05/07/2017 |