Provider Demographics
NPI:1487678728
Name:HANNER, LINDA J (PHD HSPP)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:HANNER
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1536
Mailing Address - Country:US
Mailing Address - Phone:765-569-5350
Mailing Address - Fax:765-569-5340
Practice Address - Street 1:1008 W OHIO ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1536
Practice Address - Country:US
Practice Address - Phone:765-569-5350
Practice Address - Fax:765-569-5340
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041104A103TA0400X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200119440BMedicaid
IN224190AOtherMEDICARE PTAN
IN801182000OtherMAGELLAN
IN753163279OtherSAGAMORE
IN000000356184OtherANTHEM