Provider Demographics
NPI:1548834922
Name:HATINEN, BREANNA MARIE MAE (MSED)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE MAE
Last Name:HATINEN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1801
Mailing Address - Country:US
Mailing Address - Phone:218-451-1848
Mailing Address - Fax:
Practice Address - Street 1:925 E SUPERIOR ST STE 113
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2253
Practice Address - Country:US
Practice Address - Phone:218-310-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program