Individual
MR. RICKY THATSANAVONGSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 24TH AVE S STE 260, SEATTLE, WA 98144-4644
(206) 446-8813
Mailing address
2100 24TH AVE S STE 260, SEATTLE, WA 98144-4644
(206) 446-8813
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026117
—
WA
Enumeration date
11/02/2018
Last updated
11/05/2018
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