1336745793 NPI number — SKYLAR BLAKE RADFORD M.ED., BCBA, LBA

Table of content: SKYLAR BLAKE RADFORD M.ED., BCBA, LBA (NPI 1336745793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336745793 NPI number — SKYLAR BLAKE RADFORD M.ED., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADFORD
Provider First Name:
SKYLAR
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EPLING
Provider Other First Name:
SKYLAR
Provider Other Middle Name:
BLAKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336745793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7719 PERREGRINE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-5955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-977-5098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7719 PERREGRINE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-5955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-977-5098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  BA61115658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82-4372340 . This is a "PREMERA AND REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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