Provider Demographics
NPI:1104164870
Name:LINGBLOOM, ALLISON (BA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:LINGBLOOM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:NEWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:730 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4410
Mailing Address - Country:US
Mailing Address - Phone:360-303-3654
Mailing Address - Fax:
Practice Address - Street 1:13525 32ND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8613
Practice Address - Country:US
Practice Address - Phone:206-365-0809
Practice Address - Fax:206-365-0872
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60174649Medicaid