MEDICARE: DAVID E HANNA PH.D.

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	103TC0700X	Clinical Psychologist	0604	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689762619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E HANNA PH.D.

Provider Business Mailing Address
First Line	:	4360 CALEVARES DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1301
Country	:	US
Telephone Number	:	859-619-9615
Fax Number	:

Provider Business Practice Location Address
First Line	:	4360 CALEVARES DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1301
Country	:	US
Telephone Number	:	859-619-9615
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	02/10/2015

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