Healthcare Provider Details

I. General information

NPI: 1477259075
Provider Name (Legal Business Name): AUTUMN BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6409 E MILL PLAIN BLVD
VANCOUVER WA
98661-7454
US

IV. Provider business mailing address

12 S 68TH CT
RIDGEFIELD WA
98642-3438
US

V. Phone/Fax

Practice location:
  • Phone: 360-718-8376
  • Fax:
Mailing address:
  • Phone: 503-451-4196
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61419055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: