Provider Demographics
NPI:1407402340
Name:PEARL, MADISON ISABEL (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ISABEL
Last Name:PEARL
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 NW MALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7900
Mailing Address - Country:US
Mailing Address - Phone:206-380-3009
Mailing Address - Fax:208-416-6922
Practice Address - Street 1:1445 NW MALL ST STE 2
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-7900
Practice Address - Country:US
Practice Address - Phone:206-380-3009
Practice Address - Fax:208-416-6922
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61418409103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-64469OtherBEHAVIOR ANALYST CERTIFICATION BOARD