Individual
IVY DIANE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8725 S 212TH ST, KENT, WA 98031-1921
(425) 658-3016
Mailing address
1909 O CT SE, AUBURN, WA 98002-6955
(760) 223-3919
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CBT.CB.61461846
WA
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/26/2023
Last updated
04/09/2026
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