Provider Demographics
NPI:1336745793
Name:RADFORD, SKYLAR BLAKE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:BLAKE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:BLAKE
Other - Last Name:EPLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7719 PERREGRINE PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5955
Mailing Address - Country:US
Mailing Address - Phone:425-977-5098
Mailing Address - Fax:
Practice Address - Street 1:7719 PERREGRINE PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5955
Practice Address - Country:US
Practice Address - Phone:425-977-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61115658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA82-4372340OtherPREMERA AND REGENCE