Provider Demographics
NPI:1124574264
Name:MATHIOT, HANNAH (LMSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MATHIOT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW
Mailing Address - Street 1:920 DIANA ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1987
Mailing Address - Country:US
Mailing Address - Phone:231-845-6294
Mailing Address - Fax:843-845-7095
Practice Address - Street 1:3300 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2810
Practice Address - Country:US
Practice Address - Phone:616-942-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker