MEDICARE: AEISHA MAKEDA HODGE

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	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1689233744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AEISHA MAKEDA HODGE

Provider Business Mailing Address
First Line	:	12023 BISSONNET ST APT 609
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1447
Country	:	US
Telephone Number	:	281-500-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	12023 BISSONNET ST APT 609
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1447
Country	:	US
Telephone Number	:	281-500-0942
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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Directions to “ AEISHA MAKEDA HODGE ” Practice Location

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