MEDICARE: HANI HASSAN

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center		MN
2	1041C0700X	Clinical Social Worker		MN

General Provider Information

NPI Number	:	1942911631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANI HASSAN

Provider Business Mailing Address
First Line	:	1913 BROADWAY ST NE # 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2627
Country	:	US
Telephone Number	:	763-353-0763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 BROADWAY ST NE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2627
Country	:	US
Telephone Number	:	763-353-0763
Fax Number	:	763-260-9898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	04/14/2026

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Directions to “ HANI HASSAN ” Practice Location

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