MEDICARE: ALEXANDRA GIVICH

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	:	1700472818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GIVICH

Provider Business Mailing Address
First Line	:	1488 S GREEN ST APT A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1488 S GREEN ST APT A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2153
Country	:	US
Telephone Number	:	414-477-9752
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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