Provider Demographics
NPI:1487235750
Name:KOCH, SHELBY KRISTINE I (BCBA)
Entity type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:KRISTINE
Last Name:KOCH
Suffix:I
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 1:14915 38TH DR SE UNIT S1148
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4227
Mailing Address - Country:US
Mailing Address - Phone:425-984-4041
Mailing Address - Fax:
Practice Address - Street 1:3231 41ST AVE SW APT 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3400
Practice Address - Country:US
Practice Address - Phone:425-984-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB1035097106E00000X
WABA61176953103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst