Provider Demographics
NPI:1003534249
Name:HATCH, SHANNON (RBT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3835
Mailing Address - Country:US
Mailing Address - Phone:603-812-5521
Mailing Address - Fax:844-866-8240
Practice Address - Street 1:100 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3835
Practice Address - Country:US
Practice Address - Phone:603-812-5521
Practice Address - Fax:844-866-8240
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRBT-19-84099106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician