MEDICARE: COURTNEY YANOVITCH

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	RBT-19-77244	HI

General Provider Information

NPI Number	:	1720639123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY YANOVITCH

Provider Business Mailing Address
First Line	:	7192 KALANIANAOLE HWY STE A143A
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7192 KALANIANAOLE HWY STE A143A #314
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1849
Country	:	US
Telephone Number	:	877-584-6227
Fax Number	:

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	09/26/2019

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Directions to “ COURTNEY YANOVITCH ” Practice Location

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