Provider Demographics
NPI:1003687062
Name:DEJONG, HANNAH CLAIRE (LPC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:CLAIRE
Last Name:DEJONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:CLAIRE
Other - Last Name:MINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2936
Practice Address - Country:US
Practice Address - Phone:208-883-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-10046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health