Individual
DR. GUSTY-LEE BOULWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD-BCBA-D
Contact information
Practice address
6239 WOODLAWN AVE N, SEATTLE, WA 98103-5716
(206) 271-4796
(206) 729-2660
Mailing address
6239 WOODLAWN AVE N, SEATTLE, WA 98103-5716
(206) 271-4796
(206) 729-2660
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-02-0744
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020744
BCBA
—
Enumeration date
02/19/2016
Last updated
02/19/2016
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