Provider Demographics
NPI:1871056572
Name:SCHNEIDERHAN, KAYLEE (MED, LBA, BCBA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:SCHNEIDERHAN
Suffix:
Gender:F
Credentials:MED, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26115 195TH PL SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5010
Mailing Address - Country:US
Mailing Address - Phone:206-919-8356
Mailing Address - Fax:
Practice Address - Street 1:651 STRANDER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2914
Practice Address - Country:US
Practice Address - Phone:206-313-8840
Practice Address - Fax:206-641-9540
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1115245Medicaid