Provider Demographics
NPI:1346890324
Name:TALLEY, KIANA MARIEL (BCBA)
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:MARIEL
Last Name:TALLEY
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 1:1631 15TH AVE W STE 112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2792
Mailing Address - Country:US
Mailing Address - Phone:206-283-1631
Mailing Address - Fax:
Practice Address - Street 1:1631 15TH AVE W STE 112
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2792
Practice Address - Country:US
Practice Address - Phone:206-283-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst