Active NPI
Kellie Diana Fowler, CBT
- Behavior Technician
- Seattle, WA
National Provider Identifier
1780107276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 60780423
- Practice address
- 3214 W McGraw St Ste 212
Seattle, WA 98199-3239 - Phone
- (206) 453-4882
- NPI assigned
- Jul 17, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 60780423 | WA | Primary |
Addresses
Primary practice location
3214 W McGraw St Ste 212
Seattle, WA 98199-3239
Mailing address
5437 Fauntleroy Way SW Apt N
Seattle, WA 98136-1557
Phone (914) 419-7140
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 |
|---|---|---|---|
| 60780423 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500249600000",
"number": "1780107276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5437 FAUNTLEROY WAY SW APT N",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981361557",
"telephone_number": "914-419-7140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3214 W MCGRAW ST STE 212",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981993239",
"telephone_number": "206-453-4882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLER",
"first_name": "KELLIE",
"middle_name": "DIANA",
"name_prefix": "Miss",
"credential": "CBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-17",
"last_updated": "2017-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "WA",
"license": "60780423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.