MEDICARE: STEFAN ANDREW HORBANCZUK

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	:	1932586641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN ANDREW HORBANCZUK

Provider Business Mailing Address
First Line	:	9750 3RD AVE NE
Second Line	:	SUITE #305
City	:	SEATTLE
State	:	WA
Zip	:	98115-2058
Country	:	US
Telephone Number	:	206-535-8876
Fax Number	:

Provider Business Practice Location Address
First Line	:	8117 STONE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4414
Country	:	US
Telephone Number	:	206-535-8876
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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