Provider Demographics
NPI:1669965760
Name:HAGGERTY, COLIN MICHAEL JR (M ED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:MICHAEL
Last Name:HAGGERTY
Suffix:JR
Gender:M
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 AURORA AVE N APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2269
Mailing Address - Country:US
Mailing Address - Phone:858-952-9609
Mailing Address - Fax:
Practice Address - Street 1:7011 MCDOUGALL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5460
Practice Address - Country:US
Practice Address - Phone:480-242-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61128062103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician