Provider Demographics
NPI:1396037198
Name:WILDASIN, HANNAH REES (PHD, MA, LPC, LCPC)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:REES
Last Name:WILDASIN
Suffix:
Gender:F
Credentials:PHD, MA, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-0623
Mailing Address - Country:US
Mailing Address - Phone:610-360-3864
Mailing Address - Fax:
Practice Address - Street 1:3400 BATH PIKE STE 304
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2486
Practice Address - Country:US
Practice Address - Phone:610-360-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC013203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)