Provider Demographics
NPI:1356892541
Name:PALMER, BETHANY LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E SPOKANE FALLS BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5081
Mailing Address - Country:US
Mailing Address - Phone:509-328-1582
Mailing Address - Fax:877-376-3335
Practice Address - Street 1:528 E SPOKANE FALLS BLVD STE 13-14
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5050
Practice Address - Country:US
Practice Address - Phone:509-999-5657
Practice Address - Fax:877-376-3335
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61079054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA61079054Medicaid