Basic Information
| Provider Information | |||||||||
| NPI: | 1346790615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLGERSON | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 UNION ST | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945012642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105295995 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5729 SONOMA DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945667782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254622281 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2016 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-23151 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.