Most Relevant Information
Provider Data
| NPI Number: | 1003240177 |
| Provider Name: | MICHAEL CONNOLLY |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | CG60396523 |
Most Important Dates
| Enumeration Date: | 08/26/2013 |
| Last Updated: | 08/26/2013 |
Provider Practice Location
1826 MARKHAM AVE NE # B
TACOMA
WA
984221015
Practice Location Phone/Fax
| Phone: | 5416376855 |
| Fax: |
Provider Mailing Location
PO BOX 3841
FEDERAL WAY
WA
980633841
Provider Mailing Phone/Fax
| Phone: | 5416376855 |
| Fax: |