Healthcare Provider Details

I. General information

NPI: 1861979049
Provider Name (Legal Business Name): HANNAH GLEASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 05/20/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 1ST AVE STE 101
BROOMFIELD CO
80020-3786
US

IV. Provider business mailing address

1601 S MOPAC EXPY SUITE C-300
AUSTIN TX
78746-3858
US

V. Phone/Fax

Practice location:
  • Phone: 512-920-1239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48068
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: