Healthcare Provider Details

I. General information

NPI: 1114841178
Provider Name (Legal Business Name): KENIA JASMIN PIMENTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 HIGHSCHOOL RD
MABTON WA
98935-9420
US

IV. Provider business mailing address

842 HIGHSCHOOL RD
MABTON WA
98935-9420
US

V. Phone/Fax

Practice location:
  • Phone: 509-302-6786
  • Fax:
Mailing address:
  • Phone: 509-302-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: