Healthcare Provider Details

I. General information

NPI: 1114518024
Provider Name (Legal Business Name): KELLSIE M HANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLSIE M FOSTER

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 FREDERICK ST
NILES OH
44446-2722
US

IV. Provider business mailing address

150 E MARKET ST
WARREN OH
44481-1141
US

V. Phone/Fax

Practice location:
  • Phone: 330-989-5091
  • Fax:
Mailing address:
  • Phone: 330-394-6342
  • Fax: 330-394-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number21871801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: