Healthcare Provider Details

I. General information

NPI: 1689468647
Provider Name (Legal Business Name): HANNAH KUMMER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 NE 65TH ST
VANCOUVER WA
98662-5527
US

IV. Provider business mailing address

11801 NE 65TH ST STE A&B
VANCOUVER WA
98662-5527
US

V. Phone/Fax

Practice location:
  • Phone: 360-558-5790
  • Fax:
Mailing address:
  • Phone: 360-558-5790
  • Fax: 360-558-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61662464
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61662464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: