Healthcare Provider Details

I. General information

NPI: 1831490788
Provider Name (Legal Business Name): EILEEN KLEIN FELDMAN PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHDD COLUMBIA RD BOX 357920 ROOM 205
SEATTLE WA
98195-7920
US

IV. Provider business mailing address

CHDD COLUMBIA RD BOX 357920 ROOM 205
SEATTLE WA
98195-7920
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-0117
  • Fax:
Mailing address:
  • Phone: 857-939-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 60260580
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3421
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: