Organization
GENEVIEVE WILKERSON HANSEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENEVIEVE MARIE WILKERSON HANSEN (INTERVENTION PROFESSIONAL)
(707) 815-3858
Entity
Organization
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
Enumeration date
09/09/2021
Last updated
09/09/2021
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