Provider Demographics
NPI:1083189187
Name:CREASON, JENEAN RENE (BCBA, LBA, MIT)
Entity Type:Individual
Prefix:
First Name:JENEAN
Middle Name:RENE
Last Name:CREASON
Suffix:
Gender:F
Credentials:BCBA, LBA, MIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 ISSAQUAH PINE LAKE RD SE X-07
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-6218
Mailing Address - Country:US
Mailing Address - Phone:206-708-5084
Mailing Address - Fax:
Practice Address - Street 1:4425 ISSAQUAH PINE LAKE RD SE X-07
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-6218
Practice Address - Country:US
Practice Address - Phone:206-708-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61173748103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA61173748OtherLICENSED BEHAVIOR ANALYST
1-21-49022OtherBOARD ANALYST CERTIFICATION BOARD