Provider Demographics
NPI:1033627583
Name:STUDEBAKER, HANNAH M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:M
Last Name:STUDEBAKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:M
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3266 SYCAMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-756-8524
Mailing Address - Fax:815-756-1841
Practice Address - Street 1:3266 SYCAMORE ROAD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-756-8524
Practice Address - Fax:815-756-1841
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-019312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist