Healthcare Provider Details

I. General information

NPI: 1528915519
Provider Name (Legal Business Name): HANNAH RENEE CRONIN RT1431260226
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

IV. Provider business mailing address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

V. Phone/Fax

Practice location:
  • Phone: 209-553-0798
  • Fax: 209-224-5076
Mailing address:
  • Phone: 209-553-0798
  • Fax: 209-224-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1431260226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: