Provider Demographics
NPI:1487958286
Name:HANSON, VICKI S (BCBA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:S
Last Name:HANSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 FAWN CIR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1575
Mailing Address - Country:US
Mailing Address - Phone:636-212-0949
Mailing Address - Fax:636-333-2790
Practice Address - Street 1:5001 FAWN CIR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1575
Practice Address - Country:US
Practice Address - Phone:636-212-0949
Practice Address - Fax:636-333-2790
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1-03-1085OtherBCBA CERTIFICANT NUMBER