Provider Demographics
NPI:1356052211
Name:DOBSON, HANNAH (MA,AMFT, QMHP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:DOBSON
Suffix:
Gender:F
Credentials:MA,AMFT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10286
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-0286
Mailing Address - Country:US
Mailing Address - Phone:309-713-1485
Mailing Address - Fax:
Practice Address - Street 1:7210 N VILLA LAKE DR STE C
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8290
Practice Address - Country:US
Practice Address - Phone:309-713-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.001018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist