Provider Demographics
NPI:1386221364
Name:TADDIE, HANNAH PRESCOTT
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:PRESCOTT
Last Name:TADDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 MORRIS PARK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2347
Mailing Address - Country:US
Mailing Address - Phone:814-574-6664
Mailing Address - Fax:
Practice Address - Street 1:1959 THORNAPPLE RIVER DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9706
Practice Address - Country:US
Practice Address - Phone:616-226-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137017101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor