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General NPI Number Information
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NPI Number | 1467260570
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Entity Type | Individual
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Provider Name | VIVIANA ALICIA VALENZUELA AHUMADA
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 627 W FRANKLIN ST
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City | SHELTON
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State | WA
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Zip | 98584-3504
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Country | US
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Telephone | 360-763-5610
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 257, PMB 10990
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City | OLYMPIA
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State | WA
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Zip | 98507-0257
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Country | US
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Telephone | 360-584-7581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | WA
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