Healthcare Provider Details

I. General information

NPI: 1386410876
Provider Name (Legal Business Name): HANNAH SHAE HAEDIKE-SWIFT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH SHAE SWIFT MA, NCC, LPC

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 NE SEQUOIA CT
OAK GROVE MO
64075-5501
US

IV. Provider business mailing address

1307 NE SEQUOIA CT
OAK GROVE MO
64075-5501
US

V. Phone/Fax

Practice location:
  • Phone: 636-577-9819
  • Fax:
Mailing address:
  • Phone: 636-577-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.2026041619
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: