MEDICARE: HANNAH LYNNE HARNESS

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	106S00000X	Behavior Technician	20-146080	MI

General Provider Information

NPI Number	:	1790613552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH LYNNE HARNESS

Provider Business Mailing Address
First Line	:	5235 ROOT STATION RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-9519
Country	:	US
Telephone Number	:	517-612-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S SANDSTONE RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8983
Country	:	US
Telephone Number	:	517-612-6146
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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