Provider Demographics
NPI:1215240569
Name:HANCOCK, ALLISON MARIE (BA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 GEORGIA LN
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7809
Mailing Address - Country:US
Mailing Address - Phone:307-747-4477
Mailing Address - Fax:
Practice Address - Street 1:3675 GEORGIA LN
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-7809
Practice Address - Country:US
Practice Address - Phone:307-747-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker