MEDICARE: ETHAN RETONIO

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

General Provider Information

NPI Number	:	1457163503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN RETONIO

Provider Business Mailing Address
First Line	:	31408 28TH AVE S # APTB106
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3377 BETHEL RD SE STE 107
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-5608
Country	:	US
Telephone Number	:	833-747-4222
Fax Number	:

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

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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Directions to “ ETHAN RETONIO ” Practice Location

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