MEDICARE: LESLIE BENDJOUYA CO 60235241

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	60235241	WA

General Provider Information

NPI Number	:	1033637558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BENDJOUYA CO 60235241

Provider Business Mailing Address
First Line	:	1305 SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2828
Country	:	US
Telephone Number	:	206-323-0930
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/05/2017

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