Healthcare Provider Details

I. General information

NPI: 1245927300
Provider Name (Legal Business Name): HAILLEY RENE LOOP BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18422 103RD AVE NE
BOTHELL WA
98011-3410
US

IV. Provider business mailing address

19143 15TH AVE NW
SHORELINE WA
98177-2723
US

V. Phone/Fax

Practice location:
  • Phone: 425-949-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number61638965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: