Provider Demographics
NPI:1023628526
Name:AGOSTA, KAITLIN JOYCE (BCBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JOYCE
Last Name:AGOSTA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 CAPITOL BLVD SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5205
Mailing Address - Country:US
Mailing Address - Phone:360-456-2237
Mailing Address - Fax:
Practice Address - Street 1:6330 CAPITOL BLVD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5205
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALABA.AB.61493617106E00000X
106S00000X
WABA61603313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician