MEDICARE: SAVANNAH SANCRICCA M.S. BCBA

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	BA60978820	WA

General Provider Information

NPI Number	:	1275184806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH SANCRICCA M.S. BCBA

Provider Business Mailing Address
First Line	:	155 FLORENTIA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-1716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 W WHEELER ST # 302
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3245
Country	:	US
Telephone Number	:	864-404-9632
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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