MEDICARE: ELIZABETH ANNA AYIVI-GA TOGBASSA MED, LABA, RBT

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		WA

General Provider Information

NPI Number	:	1548783830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNA AYIVI-GA TOGBASSA MED, LABA, RBT

Provider Business Mailing Address
First Line	:	2110 IRON ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4123
Country	:	US
Telephone Number	:	808-364-7486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 IRON ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225
Country	:	US
Telephone Number	:	808-364-7486
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/21/2022

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