Provider Demographics
NPI:1164256277
Name:SCHWARZBACH, JONATHAN L
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:SCHWARZBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 UNIVERSITY WAY NE APT 604
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3647
Mailing Address - Country:US
Mailing Address - Phone:832-477-3333
Mailing Address - Fax:
Practice Address - Street 1:5240 UNIVERSITY WAY NE APT 604
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3647
Practice Address - Country:US
Practice Address - Phone:832-477-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61402350106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician