MEDICARE: HANNAH STUECKLE

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	172V00000X	Community Health Worker
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1235558040	OTHER	CA	172V00000X

General Provider Information

NPI Number	:	1235558040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH STUECKLE

Provider Business Mailing Address
First Line	:	5470 SHILSHOLE AVE NW STE 510
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 SHILSHOLE AVE NW STE 510
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4040
Country	:	US
Telephone Number	:	206-619-7628
Fax Number	:

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	01/31/2022

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Directions to “ HANNAH STUECKLE ” Practice Location

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