Healthcare Provider Details

I. General information

NPI: 1164961025
Provider Name (Legal Business Name): WICKLER BEHAVIORAL CONSULTING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 01/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 182ND ST SE
BOTHELL WA
98012-6275
US

IV. Provider business mailing address

632 182ND ST SE
BOTHELL WA
98012-6275
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-9784
  • Fax: 425-361-2952
Mailing address:
  • Phone: 425-246-9784
  • Fax: 425-361-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-20417
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-23299
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.60659106
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8640
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-14776
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierN/A
Identifier TypeOTHER
Identifier State
Identifier IssuerPRIVATE INSURANCE

VIII. Authorized Official

Name: MRS. KARLEE D'ANN WICKLER
Title or Position: OWNER
Credential: MD
Phone: 425-246-9784