Individual
TAYLER HANCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 EAST BROADWAY, JACKSON, WY 83001
(804) 614-5853
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
(804) 614-5853
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-63956
UT
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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