Provider Demographics
NPI:1679982847
Name:PIPE-CAMPBELL, KELLY ALICE (MED BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ALICE
Last Name:PIPE-CAMPBELL
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1083 SW MT MARKHAM PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3502
Mailing Address - Country:US
Mailing Address - Phone:559-303-6310
Mailing Address - Fax:425-369-7134
Practice Address - Street 1:1083 SW MT MARKHAM PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3502
Practice Address - Country:US
Practice Address - Phone:559-303-6310
Practice Address - Fax:425-369-7134
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst