Healthcare Provider Details

I. General information

NPI: 1053277533
Provider Name (Legal Business Name): ZACH DAVID HANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E HALSEY ST
REPUBLIC MO
65738-2244
US

IV. Provider business mailing address

107 E HALSEY ST
REPUBLIC MO
65738-2244
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-7595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-472328
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: