Provider Demographics
NPI:1710356076
Name:WEITERING, MARY KATHARINE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:WEITERING
Suffix:
Gender:
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHARINE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2624 146TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-6456
Mailing Address - Country:US
Mailing Address - Phone:425-417-5021
Mailing Address - Fax:
Practice Address - Street 1:2624 146TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-6456
Practice Address - Country:US
Practice Address - Phone:425-417-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61489025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst