Provider Demographics
NPI:1396277869
Name:MILLANES, YEGENNALYN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:YEGENNALYN
Middle Name:
Last Name:MILLANES
Suffix:
Gender:F
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 1:1900 COMMERCE ST MDS-101
Mailing Address - Street 2:UW AUTISM CENTER - TACOMA BOX 358455
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3100
Mailing Address - Country:US
Mailing Address - Phone:619-219-1963
Mailing Address - Fax:
Practice Address - Street 1:1900 COMMERCE ST MDS-101
Practice Address - Street 2:UW AUTISM CENTER - TACOMA BOX 358455
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3100
Practice Address - Country:US
Practice Address - Phone:619-219-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61079619103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst