Provider Demographics
NPI:1144612342
Name:PATTY, DESIREE (BCBA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:PATTY
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 1:7111 MARSHALL AVE SE APT 107
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8283
Mailing Address - Country:US
Mailing Address - Phone:253-592-3426
Mailing Address - Fax:
Practice Address - Street 1:17404 MERIDIAN E STE F125
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6234
Practice Address - Country:US
Practice Address - Phone:253-262-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60907045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst