Healthcare Provider Details

I. General information

NPI: 1356969760
Provider Name (Legal Business Name): BLANCA SELENE VARELA-TROTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E MAIN AVE
PUYALLUP WA
98372
US

IV. Provider business mailing address

1622 157TH STREET CT E
TACOMA WA
98445-3318
US

V. Phone/Fax

Practice location:
  • Phone: 253-339-6094
  • Fax:
Mailing address:
  • Phone: 253-882-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: