Provider Demographics
NPI:1497047047
Name:PENNEY, MELANIE LYNN (BS, BCABA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:PENNEY
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 39TH ST
Mailing Address - Street 2:#209
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4952
Mailing Address - Country:US
Mailing Address - Phone:903-229-3973
Mailing Address - Fax:
Practice Address - Street 1:201 NW 39TH ST
Practice Address - Street 2:#209
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4952
Practice Address - Country:US
Practice Address - Phone:903-229-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0113999103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst