MEDICARE: EXCEPTIONAL BEHAVIOR

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578767208	OTHER	FL	INDIVIDUAL

General Provider Information

NPI Number	:	1942538996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL BEHAVIOR

Provider Business Mailing Address
First Line	:	1015B GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-215-6441
Fax Number	:	850-215-6457

Provider Business Practice Location Address
First Line	:	1015B GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-215-6441
Fax Number	:	850-215-6457

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KAREN SWOBODA
Credential	:
Telephone Number	:	850-215-6441

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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Directions to “EXCEPTIONAL BEHAVIOR ” Practice Location

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