Provider Demographics
NPI:1215571542
Name:WOOD, MICHELLE SARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SARAH
Last Name:WOOD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:SARAH
Other - Last Name:SAXE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11302 NE 36TH PL APT F220
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7765
Mailing Address - Country:US
Mailing Address - Phone:206-245-4382
Mailing Address - Fax:
Practice Address - Street 1:6021 244TH ST SW STE 400
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5426
Practice Address - Country:US
Practice Address - Phone:206-245-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60996016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst