Provider Demographics
NPI:1225665722
Name:HAUCK, MELEESA (RBT)
Entity Type:Individual
Prefix:
First Name:MELEESA
Middle Name:
Last Name:HAUCK
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 1:10650 E BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2653
Mailing Address - Country:US
Mailing Address - Phone:800-536-2340
Mailing Address - Fax:
Practice Address - Street 1:10650 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2653
Practice Address - Country:US
Practice Address - Phone:800-536-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1983744106S00000X
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1983744OtherRBT