Healthcare Provider Details

I. General information

NPI: 1780456988
Provider Name (Legal Business Name): HANNA BROOKE PRUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4284 TRAIL BOSS DR STE 110
CASTLE ROCK CO
80104-7521
US

IV. Provider business mailing address

3403 FELLSWOOP CT
CASTLE ROCK CO
80108-7908
US

V. Phone/Fax

Practice location:
  • Phone: 720-512-3970
  • Fax:
Mailing address:
  • Phone: 303-808-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: