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NPI Code Detail

MEDICARE: JENIFER CATHERINE HAMILTON

MEDICARE: JENIFER CATHERINE HAMILTON
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
1103K00000XBehavior Analyst1-18-29600CA

General Provider Information

NPI Number : 1578047940
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENIFER CATHERINE HAMILTON
Provider Business Mailing Address
First Line : 160 WIKIUP DR STE 102
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-7776
Country : US
Telephone Number : 510-342-4631
Fax Number :
Provider Business Practice Location Address
First Line : 160 WIKIUP DR STE 102
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-7776
Country : US
Telephone Number : 510-342-4631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2018
Last Update Date : 09/20/2018

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Directions to “ JENIFER CATHERINE HAMILTON ” Practice Location

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