MEDICARE: LEAH TANGEMAN

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	106S00000X	Behavior Technician		WA

General Provider Information

NPI Number	:	1134786668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH TANGEMAN

Provider Business Mailing Address
First Line	:	7918 WARBLER CT SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98513-5555
Country	:	US
Telephone Number	:	360-819-7452
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 W WHEELER ST # 302
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3245
Country	:	US
Telephone Number	:	206-453-4882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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Directions to “ LEAH TANGEMAN ” Practice Location

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