Healthcare Provider Details

I. General information

NPI: 1780406124
Provider Name (Legal Business Name): LINDSEY RAYE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 N HAMILTON ST
SPOKANE WA
99207-2474
US

IV. Provider business mailing address

2022 EASTERN DR
OAK HARBOR WA
98277-3430
US

V. Phone/Fax

Practice location:
  • Phone: 360-632-1708
  • Fax:
Mailing address:
  • Phone: 360-632-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLABA.AB.70108258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: