Healthcare Provider Details

I. General information

NPI: 1083246144
Provider Name (Legal Business Name): BRIGITTE BONACI CB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 216TH PL NE
SAMMAMISH WA
98074-4115
US

IV. Provider business mailing address

3276 CALIFORNIA AVE SW # A
SEATTLE WA
98116-3305
US

V. Phone/Fax

Practice location:
  • Phone: 425-588-8220
  • Fax:
Mailing address:
  • Phone: 425-691-6847
  • Fax: 208-416-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61482376
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61041162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: