Provider Demographics
NPI:1861839888
Name:BADGER, MATT THOMAS (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:THOMAS
Last Name:BADGER
Suffix:
Gender:M
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8342
Mailing Address - Country:US
Mailing Address - Phone:206-552-6724
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4278
Practice Address - Country:US
Practice Address - Phone:206-552-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst