Provider Demographics
NPI:1396393880
Name:HANNA, ELIZABETH STEWART
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STEWART
Last Name:HANNA
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 1:711 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3646
Mailing Address - Country:US
Mailing Address - Phone:630-877-3840
Mailing Address - Fax:
Practice Address - Street 1:1N141 COUNTY FARM RD STE 130
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2086
Practice Address - Country:US
Practice Address - Phone:630-752-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490132751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical