Healthcare Provider Details

I. General information

NPI: 1588502637
Provider Name (Legal Business Name): HANNAH O IMOHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

IV. Provider business mailing address

10034 SE DIVISION ST APT 302
PORTLAND OR
97266-1366
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-7500
  • Fax:
Mailing address:
  • Phone: 347-971-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-457989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: