MEDICARE: ALIA NICHELLE TUCKER

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1629582119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIA NICHELLE TUCKER

Provider Business Mailing Address
First Line	:	4916 108TH STREET SOUTHWEST
Second Line	:	14
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-8703
Country	:	US
Telephone Number	:	253-861-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 108TH ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-5615
Country	:	US
Telephone Number	:	253-861-6128
Fax Number	:

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

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	11/20/2017

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Directions to “ ALIA NICHELLE TUCKER ” Practice Location

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