Provider Demographics
NPI:1679835573
Name:ERWIN-SVOBODA, SAM JOSEPH
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:JOSEPH
Last Name:ERWIN-SVOBODA
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 1:1323 YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4457
Mailing Address - Country:US
Mailing Address - Phone:253-383-3697
Mailing Address - Fax:
Practice Address - Street 1:1323 YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4457
Practice Address - Country:US
Practice Address - Phone:253-383-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor