Provider Demographics
NPI:1548600505
Name:HAZELBAKER, CALLAN LEE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CALLAN
Middle Name:LEE
Last Name:HAZELBAKER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 BENNINGTON PLACE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420
Mailing Address - Country:US
Mailing Address - Phone:843-338-3769
Mailing Address - Fax:
Practice Address - Street 1:4710 BENNINGTON PL
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7209
Practice Address - Country:US
Practice Address - Phone:843-338-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-04
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst