Healthcare Provider Details

I. General information

NPI: 1790545481
Provider Name (Legal Business Name): HANNAH FINAZZO-KRUEGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4569 KUKUI ST STE 201
KAPAA HI
96746-1775
US

IV. Provider business mailing address

1110 NE JONES RD
BEND OR
97701-3922
US

V. Phone/Fax

Practice location:
  • Phone: 808-201-2298
  • Fax:
Mailing address:
  • Phone: 808-631-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HANNAH DEBREY FINAZZO-KRUEGER
Title or Position: OWNER/MANAGER
Credential: MA, LMHC
Phone: 808-631-5731