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NPI Code Detail

MEDICARE: HANNAH GEORGENE PENDERGRASS

MEDICARE: HANNAH GEORGENE PENDERGRASS
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
1106S00000XBehavior TechnicianRBT-25-439498WA
2175T00000XPeer SpecialistCG61408653WA
3103K00000XBehavior AnalystCB61078834WA

General Provider Information

NPI Number : 1477158053
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNAH GEORGENE PENDERGRASS
Provider Business Mailing Address
First Line : 231 SE BARRINGTON DR STE 203
Second Line :
City : OAK HARBOR
State : WA
Zip : 98277-3200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 231 SE BARRINGTON DR STE 203
Second Line :
City : OAK HARBOR
State : WA
Zip : 98277-3200
Country : US
Telephone Number : 360-240-0022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 05/28/2026

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Directions to “ HANNAH GEORGENE PENDERGRASS ” Practice Location

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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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