Provider Demographics
NPI:1609362243
Name:HIAM, EE BEAN
Entity Type:Individual
Prefix:MRS
First Name:EE BEAN
Middle Name:
Last Name:HIAM
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 1:955 S CAYUGA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1919
Mailing Address - Country:US
Mailing Address - Phone:719-470-1047
Mailing Address - Fax:
Practice Address - Street 1:63 E SPAULDING AVE # W113
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-5416
Practice Address - Country:US
Practice Address - Phone:719-470-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020422225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist