Provider Demographics
NPI:1174856686
Name:STOUGHTON, ELIZABETH WYMAN (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WYMAN
Last Name:STOUGHTON
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 SOUTH GRADY WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:206-930-1989
Mailing Address - Fax:425-902-1516
Practice Address - Street 1:15 SOUTH GRADY WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:206-930-1989
Practice Address - Fax:425-902-1516
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-02-1033103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst