MEDICARE: ALLISON QUERIMIT M.ED., BCBA

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	103K00000X	Behavior Analyst	1-15-18064	WA

General Provider Information

NPI Number	:	1457721300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON QUERIMIT M.ED., BCBA

Provider Business Mailing Address
First Line	:	12332 14TH DR SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-5931
Country	:	US
Telephone Number	:	206-427-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	5031 UNIVERSITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4341
Country	:	US
Telephone Number	:	206-427-7011
Fax Number	:

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

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	04/06/2022

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