Endalech Renee Fuller

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

AB61505630 Issued in WA

Practice address

1445 NW Mall St Ste 2
Issaquah, WA 98027-7900

Phone

(425) 651-8117

NPI assigned

Nov 21, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastside Social Skills Therapy LLC

  • Preferred Provider Organization
  • Issaquah, WA
  • NPI 1659765816
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1093472383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 NW MALL ST STE 2",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980277900",
            "telephone_number": "425-651-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 NW MALL ST STE 2",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980277900",
            "telephone_number": "425-651-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ENDALECH",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-21",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "WA",
            "license": "AB61505630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annaliese Marie Froese
• Front Street Chiropractic Clinic PS
• Max Fruhwirth
• Sean Jackson Fryer, D.C.
• Andrew M. Fukuda, PT, DPT
• Ronald Lincoln Furedy, MD
• Nichole Kingham Furness, AU.D.
• Willis P Gabel, DDS, MS
• Amy Gabik
• Lisa Lawrence Galeucia, LMHC

• Assistant Behavior Analyst in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Assistant Behavior Analyst in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.