MEDICARE: SIENA TENISCI

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1790429207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIENA TENISCI

Provider Business Mailing Address
First Line	:	4013 24TH PL S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 24TH PL S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1506
Country	:	US
Telephone Number	:	425-941-1142
Fax Number	:

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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Directions to “ SIENA TENISCI ” Practice Location

Language	Start Address	Practice Location

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