Most Relevant Information
Provider Data
| NPI Number: | 1003337627 |
| Provider Name: | KELLY PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/05/2017 |
| Last Updated: | 07/05/2017 |
Provider Practice Location
1240 116TH AVE NE STE 102
BELLEVUE
WA
980043815
Practice Location Phone/Fax
| Phone: | 2064375412 |
| Fax: |
Provider Mailing Location
321 5TH AVE APT 4
KIRKLAND
WA
980336223
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |