Provider Demographics
NPI:1700210804
Name:KIDWELL, JAMES FRANCIS (MA, BCBA, CCC, AAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:KIDWELL
Suffix:
Gender:M
Credentials:MA, BCBA, CCC, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 NE 120TH ST
Mailing Address - Street 2:L201
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8906
Mailing Address - Country:US
Mailing Address - Phone:425-890-4981
Mailing Address - Fax:
Practice Address - Street 1:12040 98TH AVE NE
Practice Address - Street 2:SUITE 205
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4290
Practice Address - Country:US
Practice Address - Phone:425-890-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-12-10512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst