Healthcare Provider Details

I. General information

NPI: 1689860512
Provider Name (Legal Business Name): JENNIFER ANN HAHN B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLOMA WAY SUITE C
ROSEVILLE CA
95661-4480
US

IV. Provider business mailing address

1133 COLOMA WAY SUITE C
ROSEVILLE CA
95661-4480
US

V. Phone/Fax

Practice location:
  • Phone: 916-774-6647
  • Fax: 916-774-6456
Mailing address:
  • Phone: 916-774-6647
  • Fax: 916-774-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: