Healthcare Provider Details

I. General information

NPI: 1093325110
Provider Name (Legal Business Name): HANNAH KAPPUS QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 SW 13TH ST
BEND OR
97702-3184
US

IV. Provider business mailing address

20225 JONATHON CT
BEND OR
97703-8764
US

V. Phone/Fax

Practice location:
  • Phone: 720-696-3181
  • Fax:
Mailing address:
  • Phone: 720-696-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: