Individual
JESSICA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14434 NE 8TH ST, 300, BELLEVUE, WA 98007-4146
(425) 502-5060
Mailing address
711 W CASINO RD, 6B4, EVERETT, WA 98204-1657
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-16-22011
BACB
—
Enumeration date
05/05/2017
Last updated
05/05/2017
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