Provider Demographics
NPI:1578832838
Name:NIELSEN, MICHELLE CLAIRE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CLAIRE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 W SUNSET HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9446
Mailing Address - Country:US
Mailing Address - Phone:509-209-2690
Mailing Address - Fax:509-789-3323
Practice Address - Street 1:5709 W SUNSET HWY STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9446
Practice Address - Country:US
Practice Address - Phone:509-209-2690
Practice Address - Fax:509-789-3323
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA60759342OtherLICENSED BEHAVIOR ANALYST