Provider Demographics
NPI:1700657921
Name:KALEIDOSCOPE LLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/ LBA
Authorized Official - Phone:206-245-4382
Mailing Address - Street 1:12819 SE 38TH ST # 284
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1326
Mailing Address - Country:US
Mailing Address - Phone:206-245-4382
Mailing Address - Fax:855-560-0522
Practice Address - Street 1:14205 SE 36TH PLACE SUITE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:206-245-4382
Practice Address - Fax:855-560-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty