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General NPI Number Information
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NPI Number | 1417336223
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Entity Type | Individual
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Provider Name | AMANDA ROSE HANNA LCSW, CSAC, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 2422 N GRANDVIEW BLVD
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City | WAUKESHA
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State | WI
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Zip | 53188-6105
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Country | US
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Telephone | 262-549-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 510 HIGHVIEW DR
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City | SLINGER
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State | WI
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Zip | 53086-9588
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Country | US
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Telephone | 608-239-3975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16234-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8943-123
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License Number State | WI
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