Organization
EASTSIDE SOCIAL SKILLS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY J LATHUM M.ED, BCBA (OWNER)
(206) 380-3009
Entity
Organization
Contact information
Practice address
5436 232ND AVE SE, ISSAQUAH, WA 98029
(206) 380-3009
Mailing address
5436 232ND AVE SE, ISSAQUAH, WA 98029
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
03/26/2015
Last updated
03/26/2015
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