Healthcare Provider Details

I. General information

NPI: 1275446833
Provider Name (Legal Business Name): DUANE HAWTHORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CRAIG RD STE 127
MARYLAND HEIGHTS MO
63146
US

IV. Provider business mailing address

810 CRAIG RD STE 127
MARYLAND HEIGHTS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 305-753-3878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: