Healthcare Provider Details

I. General information

NPI: 1992211585
Provider Name (Legal Business Name): BRYANNA BURKHART M. ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 TERMINAL DR
RICHLAND WA
99354-4953
US

IV. Provider business mailing address

8019 NE 13TH AVE
VANCOUVER WA
98665-9604
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax:
Mailing address:
  • Phone: 309-984-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61201125
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61312688
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: