Provider Demographics
NPI:1003416900
Name:YU, ANGELICA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 GREENWOOD AVE N APT 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3978
Mailing Address - Country:US
Mailing Address - Phone:206-618-6971
Mailing Address - Fax:
Practice Address - Street 1:9039 GREENWOOD AVE N APT 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3978
Practice Address - Country:US
Practice Address - Phone:206-618-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-20-45628103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst