MEDICARE: LAUREN AMANDA PHILLIPS HEMMINGER PH.D., BCBA-D

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1497202717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN AMANDA PHILLIPS HEMMINGER PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	9355 E STOCKTON BLVD STE 185
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9476
Country	:	US
Telephone Number	:	916-683-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	9355 E STOCKTON BLVD STE 185
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9476
Country	:	US
Telephone Number	:	916-683-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	08/05/2024

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