Provider Demographics
NPI:1114113974
Name:HANLON, KERRI EILEEN (MA LPC CADC III MAC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:EILEEN
Last Name:HANLON
Suffix:
Gender:F
Credentials:MA LPC CADC III MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 NW FRANKLIN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2752
Mailing Address - Country:US
Mailing Address - Phone:541-306-1128
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE STE 107
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2752
Practice Address - Country:US
Practice Address - Phone:541-306-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-07-72101YA0400X
OR507243101YA0400X
ORC1852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)