MEDICARE: AMANDA HANNA PSYCHOTHERAPY LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1689401671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA HANNA PSYCHOTHERAPY LLC

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	:	608-239-3975
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA HANNA
Credential	:	LCSW, CSAC
Telephone Number	:	608-239-3975

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	03/25/2026

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