Healthcare Provider Details

I. General information

NPI: 1891267605
Provider Name (Legal Business Name): HOZHO ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NM-564
GALLUP NM
87301
US

IV. Provider business mailing address

306 NM-564
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-8922
  • Fax:
Mailing address:
  • Phone: 505-722-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIANE HILLOCK
Title or Position: PRINCIPAL
Credential:
Phone: 505-722-8922