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NPI Code Detail

MEDICARE: HANNA CONN MA

MEDICARE: HANNA CONN MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist14186695-3904UT

General Provider Information

NPI Number : 1215750583
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANNA CONN MA
Provider Business Mailing Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number : 435-915-6398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2024
Last Update Date : 11/05/2024

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Directions to “ HANNA CONN MA” Practice Location

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