MEDICARE: MRS. VERONICA LYNN CHARLTON

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	:	1780383026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA LYNN CHARLTON

Provider Business Mailing Address
First Line	:	8744 GUIDE MERIDIAN RD
Second Line	:
City	:	LYNDEN
State	:	WA
Zip	:	98264-9129
Country	:	US
Telephone Number	:	509-280-6123
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 E MAGNOLIA ST UNIT 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4580
Country	:	US
Telephone Number	:	509-280-6123
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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