MEDICARE: KAITLYN JEANNE PATRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1275276495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN JEANNE PATRICK

Provider Business Mailing Address
First Line	:	950 BROADWAY STE 301
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-4454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13106 184TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8216
Country	:	US
Telephone Number	:	425-736-9636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	06/18/2026

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Directions to “ KAITLYN JEANNE PATRICK ” Practice Location

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