Provider Demographics
NPI:1497255129
Name:FISHER, MAKALA ROSE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MAKALA
Middle Name:ROSE
Last Name:FISHER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PACIFIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4188
Mailing Address - Country:US
Mailing Address - Phone:425-258-7141
Mailing Address - Fax:
Practice Address - Street 1:900 PACIFIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4188
Practice Address - Country:US
Practice Address - Phone:425-261-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003894106S00000X
WARBT-17-39493106S00000X
WA1-20-43540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1-20-43540OtherBEHAVIOR ANALYST CERTIFICATION BOARD
WABA61093000OtherDEPARTMENT OF HEALTH