Provider Demographics
NPI:1235901315
Name:DEBESSA, HANA M
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:M
Last Name:DEBESSA
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:AMSALU MOSISA
Other - Middle Name:M
Other - Last Name:MOSISA)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 OLD BAY DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7890
Mailing Address - Country:US
Mailing Address - Phone:614-772-5298
Mailing Address - Fax:
Practice Address - Street 1:181 OLD BAY DR
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7890
Practice Address - Country:US
Practice Address - Phone:614-772-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst