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General NPI Number Information
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NPI Number | 1841646734
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Entity Type | Individual
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Provider Name | TARA HIXSON
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 19401 40TH AVE W
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City | LYNNWOOD
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State | WA
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Zip | 98036-4612
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Country | US
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Telephone | 657-444-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 3RD AVE UNIT 204
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City | SEATTLE
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State | WA
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Zip | 98121-1700
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Country | US
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Telephone | 949-527-2231
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CG 60725110
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA61065427
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License Number State | WA
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