Individual
GENEVIEVE MARIE WILKERSON HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
146 N 4TH W, REXBURG, ID 83440-1415
(707) 815-3858
Mailing address
146 N 4TH W, REXBURG, ID 83440-1415
(707) 815-3858
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0009285
—
ID
05
—
A0009299
—
ID
Enumeration date
11/05/2020
Last updated
08/10/2021
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