MEDICARE: DANIEL SNOOZY B.S.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1457771941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SNOOZY B.S.

Provider Business Mailing Address
First Line	:	11000 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6748
Country	:	US
Telephone Number	:	206-461-3614
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6748
Country	:	US
Telephone Number	:	206-461-3614
Fax Number	:

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	10/03/2016

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