Provider Demographics
NPI:1679819635
Name:KNOWLES, WENDY JEANETTE (MS, LMHC, BCBA, LB)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JEANETTE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MS, LMHC, BCBA, LB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22670
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-0670
Mailing Address - Country:US
Mailing Address - Phone:206-888-4894
Mailing Address - Fax:
Practice Address - Street 1:100 DENNY WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4049
Practice Address - Country:US
Practice Address - Phone:206-888-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60479643101YM0800X
WABA60762546103K00000X
1-12-12294103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-12-12294OtherBOARD CERTIFIED BEHAVIOR ANALYST
WALH60479643OtherLICENSED MENTAL HEALTH COUNSELOR
WABA60762546OtherLICENSED BEHAVIOR ANALYST