Penny Jane Lathum, M.ED., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

3849 Klahanie Dr SE Apt 1-101
Issaquah, WA 98029-5720

Phone

(206) 380-3009

NPI assigned

Jul 13, 2012

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

Other names 1

• Penny Jane Wade Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

Practice roles

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

• Eastside Social Skills Therapy

  • Community/Behavioral Health Agency
  • Issaquah, WA
  • NPI 1770020331
  Authorized official Same address or phone
• Eastside Social Skills Therapy LLC

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

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386633600000",
    "number": "1508111766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5436 232ND AVE SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98029",
            "telephone_number": "206-380-3009",
            "fax_number": "425-837-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3849 KLAHANIE DR SE APT 1-101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295720",
            "telephone_number": "206-380-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHUM",
        "first_name": "PENNY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "M.ED., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2013-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-10-7087",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PENNY",
            "last_name": "WADE",
            "middle_name": "JANE",
            "credential": "M.ED., BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Landesberg, MD
• Patrick Duncan Landreth
• Lisa Landrum
• Language & Learning Arts PLLC
• Alexander Peres Lanier, MA, BCBA
• Gregory Lau, DPT
• PO Kam Lau, PHARMACIST
• Emily Rose Lawrence-Pine, CNM, ARNP
• Cassandra Lawrence, OTR/L
• Jessica Lazaro

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.