Provider Demographics
NPI:1457634958
Name:DONOVAN, CAITLIN RAEANNA (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:RAEANNA
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5102
Mailing Address - Country:US
Mailing Address - Phone:503-957-5188
Mailing Address - Fax:
Practice Address - Street 1:2310 130TH AVE NE
Practice Address - Street 2:STE 103 BUILDING B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1799
Practice Address - Country:US
Practice Address - Phone:425-882-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-15-20859103K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program