Provider Demographics
NPI:1033463294
Name:HAMILTON, BOBBI RAYANN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:RAYANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1105
Mailing Address - Country:US
Mailing Address - Phone:208-891-0604
Mailing Address - Fax:
Practice Address - Street 1:2110 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1105
Practice Address - Country:US
Practice Address - Phone:208-891-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-12-5129103K00000X
ID1-16-23482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst