Healthcare Provider Details

I. General information

NPI: 1598383291
Provider Name (Legal Business Name): HANNAH RENEE PRUITT MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S POTOMAC ST STE 111
AURORA CO
80012-4527
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 720-845-6675
  • Fax: 720-372-0844
Mailing address:
  • Phone: 407-807-7798
  • Fax: 407-588-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76690
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76690
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: