Provider Demographics
NPI:1255620290
Name:ROGERS, PAUL DAVID (MA, BCBA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROY ST # 434
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4018
Mailing Address - Country:US
Mailing Address - Phone:206-905-4660
Mailing Address - Fax:
Practice Address - Street 1:5624 7TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2729
Practice Address - Country:US
Practice Address - Phone:206-905-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60134387101Y00000X
1-09-6411103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor