Provider Demographics
NPI:1184862476
Name:RANDICH, LISETTE JULIA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:JULIA
Last Name:RANDICH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5118
Mailing Address - Country:US
Mailing Address - Phone:303-859-4838
Mailing Address - Fax:
Practice Address - Street 1:9046 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5118
Practice Address - Country:US
Practice Address - Phone:303-859-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst