Provider Demographics
NPI:1174030498
Name:HERRERA, KAREN NICOLE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:NICOLE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13117 3RD AVE SE UNIT F3
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6667
Mailing Address - Country:US
Mailing Address - Phone:253-880-2602
Mailing Address - Fax:
Practice Address - Street 1:1510 140TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4572
Practice Address - Country:US
Practice Address - Phone:253-880-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61234838103K00000X
WAAB61158306106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst