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NPI Code Detail

MEDICARE: MRS. MICHELE RENEE HAZEN BCBA

MEDICARE: MRS. MICHELE RENEE HAZEN BCBA
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 Analyst2011004826MO
2320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility2011004826MO

General Provider Information

NPI Number : 1871892604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE RENEE HAZEN BCBA
Provider Business Mailing Address
First Line : 20575 COUNTY ROAD DD
Second Line :
City : CAMDEN POINT
State : MO
Zip : 64018-9193
Country : US
Telephone Number : 816-304-6141
Fax Number :
Provider Business Practice Location Address
First Line : 14155 92 HWY
Second Line :
City : PLATTE CITY
State : MO
Zip : 64079-8907
Country : US
Telephone Number : 816-608-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2011
Last Update Date : 02/21/2023

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