MEDICARE: LANDY G BARWICK

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	RBT-1621554	AZ
2	103K00000X	Behavior Analyst	BEH-000522	AZ

General Provider Information

NPI Number	:	1629584990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDY G BARWICK

Provider Business Mailing Address
First Line	:	2741 S 8TH AVE STE C
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-782-1338
Fax Number	:	928-244-0411

Provider Business Practice Location Address
First Line	:	2741 S 8TH AVE STE C
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-782-1338
Fax Number	:	928-244-0411

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	11/15/2022

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Directions to “ LANDY G BARWICK ” Practice Location

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