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NPI Code Detail

MEDICARE: HANNAH SUE VANDENBOOM

MEDICARE: HANNAH SUE VANDENBOOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst7401001701MI
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1285199281
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNAH SUE VANDENBOOM
Provider Business Mailing Address
First Line : 1195 DAM RD
Second Line :
City : BOYNE CITY
State : MI
Zip : 49712-9613
Country : US
Telephone Number : 616-322-7358
Fax Number :
Provider Business Practice Location Address
First Line : 910 SPRING ST
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2881
Country : US
Telephone Number : 616-322-7358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2019
Last Update Date : 02/11/2026

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Directions to “ HANNAH SUE VANDENBOOM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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