Healthcare Provider Details

I. General information

NPI: 1447849831
Provider Name (Legal Business Name): JORDAN JAY SLATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18422 103RD AVE NE
BOTHELL WA
98011-3410
US

IV. Provider business mailing address

1703 127TH PL SE
EVERETT WA
98208-6516
US

V. Phone/Fax

Practice location:
  • Phone: 425-949-0801
  • Fax:
Mailing address:
  • Phone: 425-248-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61473252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: