Provider Demographics
NPI:1558863126
Name:BRUCE, HANNAH JOAN
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JOAN
Last Name:BRUCE
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 1:1923 POMONA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3431
Mailing Address - Country:US
Mailing Address - Phone:240-566-6713
Mailing Address - Fax:
Practice Address - Street 1:8670 WOLFF CT STE 130
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3692
Practice Address - Country:US
Practice Address - Phone:970-775-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2023-03-27
Deactivation Date:2021-05-18
Deactivation Code:
Reactivation Date:2021-07-07
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst