Provider Demographics
NPI:1801967492
Name:HANNAHAN, ANNE (RN, MA,, LP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HANNAHAN
Suffix:
Gender:F
Credentials:RN, MA,, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 BAYARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1214
Mailing Address - Country:US
Mailing Address - Phone:651-283-0451
Mailing Address - Fax:866-381-6380
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 130B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-319-9269
Practice Address - Fax:866-381-6380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0998103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-90776OtherMEDICA OUT OF NETWORK
MN84G45BIOtherBLUECROSS BLUESHIELD