Individual
HAVEN MARLENE HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
971 E WICHITA AVE, RUSSELL, KS 67665-2444
(785) 657-7464
Mailing address
971 E WICHITA AVE, RUSSELL, KS 67665-2444
(785) 657-7464
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
12345
KS
Enumeration date
08/27/2021
Last updated
08/27/2021
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