MEDICARE: HANNAH ANDREASEN MSED, BCBA

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	103K00000X	Behavior Analyst	1-18-34370	IL

General Provider Information

NPI Number	:	1326708231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ANDREASEN MSED, BCBA

Provider Business Mailing Address
First Line	:	1343 W WINONA ST APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	847-902-3457
Fax Number	:

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

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/20/2021

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