MEDICARE: DESTANEE HENDERSON-HOSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073472668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTANEE HENDERSON-HOSLEY

Provider Business Mailing Address
First Line	:	2800 ENTERPRISE RD APT 934
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89512-1681
Country	:	US
Telephone Number	:	775-348-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	10345 PROFESSIONAL CIR STE 125
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-3100
Country	:	US
Telephone Number	:	775-348-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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