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NPI Code Detail

MEDICARE: JOSEPH OWEN YOUNGBLOOD

MEDICARE: JOSEPH OWEN YOUNGBLOOD
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 TechnicianCB61333100WA

General Provider Information

NPI Number : 1750780375
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH OWEN YOUNGBLOOD
Provider Business Mailing Address
First Line : 8725 S 212TH ST
Second Line :
City : KENT
State : WA
Zip : 98031-1921
Country : US
Telephone Number : 253-584-2170
Fax Number :
Provider Business Practice Location Address
First Line : 8725 S 212TH ST
Second Line :
City : KENT
State : WA
Zip : 98031-1921
Country : US
Telephone Number : 425-658-3016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2014
Last Update Date : 08/23/2024

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Directions to “ JOSEPH OWEN YOUNGBLOOD ” Practice Location

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