Individual
AI O ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
BOX 357921 IHCD CD-205, SEATTLE, WA 98195-3112
(206) 543-8379
Mailing address
3820 S J ST, TACOMA, WA 98418-5038
(206) 380-7066
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BA61600090
WA
Other
Enumeration date
09/12/2020
Last updated
10/11/2024
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