Provider Demographics
NPI:1922447572
Name:HATHAWAY, NELL ELIZABETH (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:NELL
Middle Name:ELIZABETH
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:ELIZABETH
Other - Last Name:SHETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1570 WILMINGTON DR STE 220
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8773
Mailing Address - Country:US
Mailing Address - Phone:808-292-0784
Mailing Address - Fax:
Practice Address - Street 1:1570 WILMINGTON DR STE 220
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8773
Practice Address - Country:US
Practice Address - Phone:253-507-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB61124821106E00000X
WACBT.CB.60846528106S00000X
WABA61259363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922447572Medicaid