MEDICARE: MRS. JENNIFER MARIE HATTERMAN LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	683-L	NV

General Provider Information

NPI Number	:	1144526427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE HATTERMAN LADC

Provider Business Mailing Address
First Line	:	6105 CROCKERY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1067
Country	:	US
Telephone Number	:	702-515-1889
Fax Number	:	702-515-1889

Provider Business Practice Location Address
First Line	:	3630 N RANCHO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3111
Country	:	US
Telephone Number	:	702-645-2544
Fax Number	:	702-823-4358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	01/15/2025

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