Provider Demographics
NPI:1487191433
Name:BACZYNSKI, HANNAH (PHD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BACZYNSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:BORHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7151 15TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6613
Mailing Address - Country:US
Mailing Address - Phone:701-364-2950
Mailing Address - Fax:
Practice Address - Street 1:7151 15TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6613
Practice Address - Country:US
Practice Address - Phone:701-364-2950
Practice Address - Fax:701-364-2953
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10071714-2501103T00000X
ND619103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist