Provider Demographics
NPI:1720323462
Name:HANSON, ROBERT WENDELL (BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WENDELL
Last Name:HANSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ROYAL OAKS DR
Mailing Address - Street 2:201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3868
Mailing Address - Country:US
Mailing Address - Phone:916-923-1789
Mailing Address - Fax:916-923-1515
Practice Address - Street 1:1901 ROYAL OAKS DR
Practice Address - Street 2:201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3868
Practice Address - Country:US
Practice Address - Phone:916-923-1789
Practice Address - Fax:916-923-1515
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12580103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst