Provider Demographics
NPI:1568841542
Name:ENGAGE ABA LLC
Entity Type:Organization
Organization Name:ENGAGE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:AIDAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:206-830-0299
Mailing Address - Street 1:4616 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4183
Mailing Address - Country:US
Mailing Address - Phone:206-830-0299
Mailing Address - Fax:
Practice Address - Street 1:4915 25TH AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5668
Practice Address - Country:US
Practice Address - Phone:206-830-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-24
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health