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General NPI Number Information
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NPI Number | 1558030999
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Entity Type | Organization
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Legal Business Name | GENEVIEVE WILKERSON HANSEN
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 146 N 4TH W
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City | REXBURG
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State | ID
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Zip | 83440-1415
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Country | US
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Telephone | 707-815-3858
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Fax |
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Provider Business Mailing Address
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Address Line | 146 N 4TH W
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City | REXBURG
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State | ID
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Zip | 83440-1415
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Country | US
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Telephone | 707-815-3858
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Fax |
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Authorized Official
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Title or Position | INTERVENTION PROFESSIONAL
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Name | GENEVIEVE MARIE WILKERSON HANSEN
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Credential |
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Telephone | 707-815-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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