Healthcare Provider Details

I. General information

NPI: 1144626342
Provider Name (Legal Business Name): TESS GELDERLOOS MA, BCBA LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 116TH AVE NE STE 102
BELLEVUE WA
98004-3815
US

IV. Provider business mailing address

1240 116TH AVE NE STE 102
BELLEVUE WA
98004-3815
US

V. Phone/Fax

Practice location:
  • Phone: 206-437-5412
  • Fax:
Mailing address:
  • Phone: 206-437-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16072
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: