Provider Demographics
NPI:1417416678
Name:VOZNYARSKIY, ANATOLIY
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:
Last Name:VOZNYARSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17128 SE 261ST ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8335
Mailing Address - Country:US
Mailing Address - Phone:253-334-7154
Mailing Address - Fax:
Practice Address - Street 1:27023 164TH. AVE SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042
Practice Address - Country:US
Practice Address - Phone:253-639-7146
Practice Address - Fax:253-639-7145
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty