Provider Demographics
NPI:1225764608
Name:FORESMAN, REBECCA RUTH ANNE (CBT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH ANNE
Last Name:FORESMAN
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:BEX
Other - Middle Name:
Other - Last Name:FORESMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CBT
Mailing Address - Street 1:930 N 104TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9234
Mailing Address - Country:US
Mailing Address - Phone:619-300-4158
Mailing Address - Fax:
Practice Address - Street 1:18311 BOTHELL EVERETT HWY STE 260
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5233
Practice Address - Country:US
Practice Address - Phone:206-437-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61175280103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61175280OtherWA DOH