Healthcare Provider Details

I. General information

NPI: 1275276495
Provider Name (Legal Business Name): KAITLYN JEANNE PATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13106 184TH AVE E
BONNEY LAKE WA
98391-8216
US

IV. Provider business mailing address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

V. Phone/Fax

Practice location:
  • Phone: 425-736-9636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: