Provider Demographics
NPI:1831547835
Name:OBERLIN, JAIMEE LEIGH (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:JAIMEE
Middle Name:LEIGH
Last Name:OBERLIN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:JAIMEE
Other - Middle Name:LEIGH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:1003 7TH AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5779
Mailing Address - Country:US
Mailing Address - Phone:425-658-3016
Mailing Address - Fax:425-658-3017
Practice Address - Street 1:1003 7TH AVE
Practice Address - Street 2:STE. A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5779
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:425-658-3017
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-16-21989103K00000X
WABA60771170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2061304Medicaid