Priscilla D. Hernandez Hacker, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY202196 Issued in ID

Practice address

828 S Washington St Ste a
Moscow, ID 83843-3055

Phone

(208) 883-7766

Fax

(208) 883-8062

NPI assigned

May 30, 2006

Last updated

May 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Educational and Psychological Services, a P.L.L.C.

  • Clinical Psychologist
  • Moscow, ID
  • NPI 1447303870
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1063469203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 S WASHINGTON ST STE A",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433055",
            "telephone_number": "208-883-7766",
            "fax_number": "208-883-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 S WASHINGTON ST STE A",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433055",
            "telephone_number": "208-883-7766",
            "fax_number": "208-883-8062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ HACKER",
        "first_name": "PRISCILLA",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2024-05-20",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY1696",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY202196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD PIN",
            "identifier": "000010149290",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS PROVIDER NUMBER",
            "identifier": "380-319",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby R Hedlund
• Thomas Parker Heikes, L.AC
• Helping Hand Family Services, LLC
• Aidan Hendricks
• Elisabeth Henry, PHARMD
• Isabella Adrianna Hernandez
• Nathaniel Heymann
• Karen Hill
• Rachel Ruby Hill
• Sterling Michael Hill

• Clinical Psychologist in Moscow, ID
• Providers in Moscow, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.