Healthcare Provider Details

I. General information

NPI: 1568056919
Provider Name (Legal Business Name): SERENA DANVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 LEWIS PL
SEDRO WOOLLEY WA
98284-4394
US

IV. Provider business mailing address

2600 ALABAMA ST STE B
BELLINGHAM WA
98229-4055
US

V. Phone/Fax

Practice location:
  • Phone: 360-318-4700
  • Fax:
Mailing address:
  • Phone: 360-318-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61002326
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: