Provider Demographics
NPI:1730742321
Name:BOYD, KATHLEEN PALISOC (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PALISOC
Last Name:BOYD
Suffix:
Gender:
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21528 16TH DR SE APT E302
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-6970
Mailing Address - Country:US
Mailing Address - Phone:828-551-6959
Mailing Address - Fax:
Practice Address - Street 1:632 182ND ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6275
Practice Address - Country:US
Practice Address - Phone:425-246-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61668057103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-25-79446OtherBACB