=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942850532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSAIAH R CAMPBELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2019
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 STEWART ST, STE 300,
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98101-1257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-371-3248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 NE 4TH ST UNIT 2804
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98056-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-371-3248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 60978446
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------