Individual
DANIELLE SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CB
Contact information
Practice address
1420 NW GILMAN BLVD # 2604, ISSAQUAH, WA 98027-5394
(805) 668-8961
(208) 416-6922
Mailing address
1420 NW GILMAN BLVD # 2604, ISSAQUAH, WA 98027-5394
(805) 668-8961
(208) 416-6922
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB60997173
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB60997173
STATE LICENSE
WA
Enumeration date
08/22/2019
Last updated
08/22/2019
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