Active NPI
Danielle Southern, CB
- Behavior Technician
- Issaquah, WA
National Provider Identifier
1104473222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB60997173
- Practice address
- 1420 NW Gilman Blvd # 2604
Issaquah, WA 98027-5394 - Phone
- (805) 668-8961
- Fax
- (208) 416-6922
- NPI assigned
- Aug 22, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CB60997173 | WA | Primary |
Addresses
Primary practice location
1420 NW Gilman Blvd # 2604
Issaquah, WA 98027-5394
Mailing address
1420 NW Gilman Blvd # 2604
Issaquah, WA 98027-5394
Phone (805) 668-8961
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CB60997173 | Other | WA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CB60997173 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566432000000",
"number": "1104473222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 NW GILMAN BLVD # 2604",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275394",
"telephone_number": "805-668-8961",
"fax_number": "208-416-6922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 NW GILMAN BLVD # 2604",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275394",
"telephone_number": "805-668-8961",
"fax_number": "208-416-6922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERN",
"first_name": "DANIELLE",
"credential": "CB",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-22",
"last_updated": "2019-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB60997173",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "CB60997173",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Issaquah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.