Provider Demographics
NPI:1669140372
Name:SPORER, GRACE ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:SPORER
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 1:1813 19TH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2861
Mailing Address - Country:US
Mailing Address - Phone:541-821-8109
Mailing Address - Fax:
Practice Address - Street 1:10020 166TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3010
Practice Address - Country:US
Practice Address - Phone:425-499-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst