Provider Demographics
NPI:1326473257
Name:MASHBURN, ELIZABETH ANN (M ED)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S 18TH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3560
Mailing Address - Country:US
Mailing Address - Phone:208-227-6542
Mailing Address - Fax:
Practice Address - Street 1:1201 S 18TH ST
Practice Address - Street 2:APT #2
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3560
Practice Address - Country:US
Practice Address - Phone:208-227-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60396384103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst