Provider Demographics
NPI:1386256196
Name:VALENTINE, HANNAH AURA
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:AURA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 W 2700 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8942
Mailing Address - Country:US
Mailing Address - Phone:210-204-4403
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST STE 303
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6617
Practice Address - Country:US
Practice Address - Phone:801-935-4172
Practice Address - Fax:801-935-4946
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician