Healthcare Provider Details

I. General information

NPI: 1427967561
Provider Name (Legal Business Name): JACKLINE KOPYT LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N 143RD ST
SEATTLE WA
98133-6803
US

IV. Provider business mailing address

195 GARFIELD PL APT 4S
BROOKLYN NY
11215-2180
US

V. Phone/Fax

Practice location:
  • Phone: 206-914-9219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number70106429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: