MEDICARE: HANNAH DIANE DEWEY

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	RBT-20-147269	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487244844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH DIANE DEWEY

Provider Business Mailing Address
First Line	:	2768 E UPLAND DR
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-3552
Country	:	US
Telephone Number	:	817-219-7560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 E FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2847
Country	:	US
Telephone Number	:	385-695-2203
Fax Number	:

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

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	01/20/2021

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Directions to “ HANNAH DIANE DEWEY ” Practice Location

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