Individual
LEILANI URQUIETA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
5112 NW TAYLOR RD, BREMERTON, WA 98312-8837
(360) 373-2536
(360) 373-4934
Mailing address
6913 TRACYTON BLVD NW, BREMERTON, WA 98311-8999
(360) 373-2536
(360) 373-4934
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
CG60354043
WA
103K00000X
Behavior Analyst
SP60267407
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020898
—
WA
Enumeration date
05/15/2013
Last updated
05/15/2013
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