Provider Demographics
NPI:1013527514
Name:MOXLEY-STEWART, HANNAH M (BS,BI)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:M
Last Name:MOXLEY-STEWART
Suffix:
Gender:F
Credentials:BS,BI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E 3RD ST APT D201
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2770
Mailing Address - Country:US
Mailing Address - Phone:559-801-4005
Mailing Address - Fax:
Practice Address - Street 1:324 E 3RD ST APT D201
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2770
Practice Address - Country:US
Practice Address - Phone:559-801-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty