Provider Demographics
NPI:1205456449
Name:WALLER, HANNAH (RBT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 REDHEAD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2300
Mailing Address - Country:US
Mailing Address - Phone:854-202-1105
Mailing Address - Fax:
Practice Address - Street 1:3850 W ANN RD STE 120
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4407
Practice Address - Country:US
Practice Address - Phone:702-323-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT1148106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician