Provider Demographics
NPI:1871970905
Name:WILLIAMS, PENNY (MED, BCBA)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22702 30TH CT SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4214
Mailing Address - Country:US
Mailing Address - Phone:425-770-8107
Mailing Address - Fax:
Practice Address - Street 1:22702 30TH CT SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4214
Practice Address - Country:US
Practice Address - Phone:425-770-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-1662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst