MEDICARE: BONNAE MARIE HAMMOND

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	:	1417571381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNAE MARIE HAMMOND

Provider Business Mailing Address
First Line	:	1938 N PENNSYLVANIA ST UNIT 4407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1324
Country	:	US
Telephone Number	:	720-474-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1938 N PENNSYLVANIA ST UNIT 4407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1324
Country	:	US
Telephone Number	:	720-474-7758
Fax Number	:

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

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	06/05/2020

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