Provider Demographics
NPI:1417510124
Name:KLEESE, HANNAH (LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KLEESE
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 GRAND AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2628
Mailing Address - Country:US
Mailing Address - Phone:612-619-7611
Mailing Address - Fax:651-964-4748
Practice Address - Street 1:1154 GRAND AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2628
Practice Address - Country:US
Practice Address - Phone:612-619-7611
Practice Address - Fax:651-964-4748
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional