MEDICARE: AMANDA ROSE HANNA LCSW, CSAC, PMH-C

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	16234-132	WI
2	1041C0700X	Clinical Social Worker	8943-123	WI

General Provider Information

NPI Number	:	1417336223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROSE HANNA LCSW, CSAC, PMH-C

Provider Business Mailing Address
First Line	:	510 HIGHVIEW DR
Second Line	:
City	:	SLINGER
State	:	WI
Zip	:	53086-9588
Country	:	US
Telephone Number	:	608-239-3975
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W BLUEMOUND RD STE 209
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3367
Country	:	US
Telephone Number	:	262-549-6600
Fax Number	:

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	03/25/2026

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