Healthcare Provider Details

I. General information

NPI: 1871311944
Provider Name (Legal Business Name): ANNA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 POLLMAN CIR
LYNDEN WA
98264-9633
US

IV. Provider business mailing address

230 POLLMAN CIR
LYNDEN WA
98264-9633
US

V. Phone/Fax

Practice location:
  • Phone: 206-571-2977
  • Fax:
Mailing address:
  • Phone: 206-571-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82308
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61619782
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-373037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: