MEDICARE: COLUMBIA ADVANCED SCIENCE, LC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-05-2471	FL

General Provider Information

NPI Number	:	1124323506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA ADVANCED SCIENCE, LC

Provider Business Mailing Address
First Line	:	9804 MADELAINE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4918
Country	:	US
Telephone Number	:	410-979-7999
Fax Number	:	410-480-8281

Provider Business Practice Location Address
First Line	:	9804 MADELAINE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4918
Country	:	US
Telephone Number	:	410-979-7999
Fax Number	:	410-480-8281

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. XIAOLI WEN
Credential	:	BCBA
Telephone Number	:	410-979-7999

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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