Healthcare Provider Details

I. General information

NPI: 1730825399
Provider Name (Legal Business Name): RAEANNE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 3RD AVE S
SEATTLE WA
98134-1923
US

IV. Provider business mailing address

4550 40TH AVE SW APT A413
SEATTLE WA
98116-4372
US

V. Phone/Fax

Practice location:
  • Phone: 540-878-0471
  • Fax:
Mailing address:
  • Phone: 540-878-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61620771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: