Provider Demographics
NPI:1881187219
Name:ABA OUTREACH OF WASHINGTON, LLC
Entity Type:Organization
Organization Name:ABA OUTREACH OF WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-898-7740
Mailing Address - Street 1:2415 240TH PL SW
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8466
Mailing Address - Country:US
Mailing Address - Phone:206-898-7740
Mailing Address - Fax:
Practice Address - Street 1:2415 240TH PL SW
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8466
Practice Address - Country:US
Practice Address - Phone:206-898-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty