Healthcare Provider Details

I. General information

NPI: 1134030091
Provider Name (Legal Business Name): KHADRO H ABDI CBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 AUBURN WAY N STE B
AUBURN WA
98002-1381
US

IV. Provider business mailing address

4508 AUBURN WAY N STE B
AUBURN WA
98002-1381
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-7038
  • Fax: 253-354-0039
Mailing address:
  • Phone: 425-246-7038
  • Fax: 253-354-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCBT.CB.70178030
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: