MEDICARE: ANTHONY KIDD

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		WA

General Provider Information

NPI Number	:	1780054684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY KIDD

Provider Business Mailing Address
First Line	:	7432 4TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-5389
Country	:	US
Telephone Number	:	206-377-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2912
Country	:	US
Telephone Number	:	206-377-9198
Fax Number	:

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

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	01/17/2025

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Directions to “ ANTHONY KIDD ” Practice Location

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