Provider Demographics
NPI:1871003327
Name:CORRON, HANNAH KAYE LOUISE (BT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:KAYE LOUISE
Last Name:CORRON
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:HEADRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:2703 SE OTIS CORLEY DR STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3414
Practice Address - Country:US
Practice Address - Phone:479-339-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AR1-22-62174103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician