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NPI Code Detail

MEDICARE: MR. RICKY THATSANAVONGSA

MEDICARE: MR. RICKY THATSANAVONGSA
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912475476
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICKY THATSANAVONGSA
Provider Business Mailing Address
First Line : 2100 24TH AVE S STE 260
Second Line :
City : SEATTLE
State : WA
Zip : 98144-4644
Country : US
Telephone Number : 206-446-8813
Fax Number :
Provider Business Practice Location Address
First Line : 2100 24TH AVE S STE 260
Second Line :
City : SEATTLE
State : WA
Zip : 98144-4644
Country : US
Telephone Number : 206-446-8813
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 11/05/2018

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Directions to “ MR. RICKY THATSANAVONGSA ” Practice Location

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