Provider Demographics
NPI:1245775287
Name:CHOUDHRY, MARIANN (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:CHOUDHRY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 PASTURE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5923
Mailing Address - Country:US
Mailing Address - Phone:909-518-5939
Mailing Address - Fax:
Practice Address - Street 1:1220 MAIN ST
Practice Address - Street 2:SUITE 424
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2953
Practice Address - Country:US
Practice Address - Phone:360-787-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst