Provider Demographics
NPI:1376948455
Name:ELLISON, KAYLA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8606 35TH AVE NE APT 118
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3678
Mailing Address - Country:US
Mailing Address - Phone:253-590-6659
Mailing Address - Fax:
Practice Address - Street 1:7412 NEWCASTLE GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-9141
Practice Address - Country:US
Practice Address - Phone:425-954-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI - 603 295 703103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst