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General NPI Number Information
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NPI Number | 1679953681
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE DOMSCHOT BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 720 S 333RD ST STE 130
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7357
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Country | US
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Telephone | 253-682-0320
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Fax | 920-857-3366
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Provider Business Mailing Address
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Address Line | 3627 212TH PL SE
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City | SAMMAMISH
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State | WA
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Zip | 98075-9211
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Country | US
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Telephone | 505-917-5234
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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 | BA60775007
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License Number State | WA
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