Provider Demographics
NPI:1760873608
Name:PELLENBARG, HOPE ELIZABETH (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:HOPE
Middle Name:ELIZABETH
Last Name:PELLENBARG
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:ELIZABETH
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:1003 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-658-3016
Mailing Address - Fax:425-658-3017
Practice Address - Street 1:1003 7TH AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:425-658-3017
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-14-16277103K00000X
1-14-16277103K00000X
WABA60770961103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077236Medicaid