MEDICARE: EMILY KATHRYN GOLDNER CBT, RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	60770805	WA

General Provider Information

NPI Number	:	1134641830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KATHRYN GOLDNER CBT, RBT

Provider Business Mailing Address
First Line	:	8129 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2135
Country	:	US
Telephone Number	:	12062188925
Fax Number	:

Provider Business Practice Location Address
First Line	:	8129 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2135
Country	:	US
Telephone Number	:	206-218-8925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	07/21/2022

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