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NPI Code Detail

MEDICARE: MICHELLE S OLSUFKA

MEDICARE: MICHELLE S OLSUFKA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1548886781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE S OLSUFKA
Provider Business Mailing Address
First Line : 123 S 10TH ST
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98274-4015
Country : US
Telephone Number : 360-610-1620
Fax Number :
Provider Business Practice Location Address
First Line : 851 SE PIONEER WAY STE 201
Second Line :
City : OAK HARBOR
State : WA
Zip : 98277-5789
Country : US
Telephone Number : 360-610-1620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2020
Last Update Date : 06/23/2020

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