Provider Demographics
NPI:1457970196
Name:BURNETT, EVELYN STERLING
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:STERLING
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 WESTLAKE AVE N UNIT 534
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4881
Mailing Address - Country:US
Mailing Address - Phone:206-867-4894
Mailing Address - Fax:
Practice Address - Street 1:22845 SE 1ST PL APT 215
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-5038
Practice Address - Country:US
Practice Address - Phone:805-668-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61046225106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician