MEDICARE: HANNIBAL & HANNIBAL, 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	1041C0700X	Clinical Social Worker	L0525	OR
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	01-11-26	OR

General Provider Information

NPI Number	:	1912119835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNIBAL & HANNIBAL, LLC

Provider Business Mailing Address
First Line	:	1419 NE 69TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-5301
Country	:	US
Telephone Number	:	503-254-1545
Fax Number	:	503-525-2846

Provider Business Practice Location Address
First Line	:	1419 NE 69TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-5301
Country	:	US
Telephone Number	:	503-254-1545
Fax Number	:	503-525-2846

Authorized Official
Title or Position	:	LLC MANAGER
Name	:	GEORGE IVAR HANNIBAL
Credential	:	MSW
Telephone Number	:	503-254-1545

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/11/2025

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