Provider Demographics
NPI:1245771716
Name:KING, HANNAH KAY
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KAY
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 E IMLAY CITY RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9461
Mailing Address - Country:US
Mailing Address - Phone:810-310-0115
Mailing Address - Fax:
Practice Address - Street 1:8570 E IMLAY CITY RD.
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444
Practice Address - Country:US
Practice Address - Phone:810-310-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician