Vicki S. Hanson, BCBA

Individual provider Active NPI Behavior Analyst · Imperial, MO

NPI 1487958286 · NPPES record last updated Jan 7, 2011

Key facts

NPI
1487958286
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Analyst 103K00000X
Practice address
5001 Fawn Cir
Imperial, MO 63052-1575
Phone
(636) 212-0949
Fax
(636) 333-2790
NPI assigned
Jan 7, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Yes

Addresses

Primary practice location

5001 Fawn Cir
Imperial, MO 63052-1575

Mailing address

5001 Fawn Cir
Imperial, MO 63052-1575
Phone (636) 212-0949

Other identifiers

IdentifierTypeStateIssuer
1-03-1085OtherMOBCBA CERTIFICANT NUMBER

Other providers in Imperial, MO

All providers in Imperial, MO · Behavior Analyst in Missouri

Sources for this page

Verify at the official NPI Registry.