Healthcare Provider Details

I. General information

NPI: 1801302039
Provider Name (Legal Business Name): HEATHER HANIFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S CRAYCROFT RD
TUCSON AZ
85711-6626
US

IV. Provider business mailing address

5947B GANNET AVE
EWA BEACH HI
96706-3256
US

V. Phone/Fax

Practice location:
  • Phone: 877-299-1655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57625
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB388215
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: