Active NPI
Shealeen Maia Kennedy, M.ED., BCBA, LBA
- Behavior Analyst
- Bainbridge Island, WA
National Provider Identifier
1770825408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BA603242577
- Practice address
- 9431 Coppertop Loop NE Unit 205
Bainbridge Island, WA 98110-3684 - Phone
- (206) 351-1811
- NPI assigned
- Mar 20, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-12-10437 | MA | |
| Behavior Analyst | 103K00000X | BA603242577 | WA | Primary |
Addresses
Primary practice location
9431 Coppertop Loop NE Unit 205
Bainbridge Island, WA 98110-3684
Mailing address
PO Box 4792
Rollingbay, WA 98061-0792
Phone (206) 351-1811
Other practice location 1
600 Deercliff Rd NE
Bainbridge Island, WA 98110-1903
Phone (206) 351-1811
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Shea@BuildingBlocksNW.com |
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BA603242577 | WA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1770825408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4792",
"city": "ROLLINGBAY",
"state": "WA",
"postal_code": "980610792",
"telephone_number": "206-351-1811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9431 COPPERTOP LOOP NE UNIT 205",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981103684",
"telephone_number": "206-351-1811"
}
],
"practiceLocations": [
{
"address_1": "600 Deercliff Rd NE",
"address_purpose": "LOCATION",
"city": "Bainbridge Island",
"state": "WA",
"postal_code": "981101903",
"country_code": "US",
"telephone_number": "206-351-1811",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "SHEALEEN",
"middle_name": "MAIA",
"name_prefix": "Ms.",
"credential": "M.ED., BCBA, LBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-20",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MA",
"license": "1-12-10437",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WA",
"license": "BA603242577",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Shea@BuildingBlocksNW.com",
"affiliation": "N",
"address_1": "9431 Coppertop Loop NE Unit 205",
"city": "Bainbridge Island",
"state": "WA",
"country_code": "US",
"postal_code": "981103684",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bainbridge Island, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.