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Individual

DR. PRISCILLA D. HERNANDEZ HACKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
828 S WASHINGTON ST STE A, MOSCOW, ID 83843-3055
(208) 883-7766
(208) 883-8062
Mailing address
828 S WASHINGTON ST STE A, MOSCOW, ID 83843-3055
(208) 883-7766
(208) 883-8062

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY202196
ID
103TC0700X
Clinical Psychologist
PY1696
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010149290
REGENCE BLUE SHIELD PIN
ID
01
380-319
DSHS PROVIDER NUMBER
WA
Enumeration date
05/30/2006
Last updated
05/20/2024
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