Healthcare Provider Details

I. General information

NPI: 1619670635
Provider Name (Legal Business Name): HANNAH C TALBOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 INDEPENDENCE BLVD
ZACHARY LA
70791-7390
US

IV. Provider business mailing address

1329 MIMOSA LN
SHONGALOO LA
71072-2425
US

V. Phone/Fax

Practice location:
  • Phone: 225-286-1547
  • Fax:
Mailing address:
  • Phone: 318-560-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: