Provider Demographics
NPI:1487859666
Name:HANNON, PRISCILLA (MSW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 W SHARP AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2460
Mailing Address - Country:US
Mailing Address - Phone:509-879-6244
Mailing Address - Fax:509-328-9919
Practice Address - Street 1:539 W SHARP AVE STE 150
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2460
Practice Address - Country:US
Practice Address - Phone:509-879-6244
Practice Address - Fax:509-328-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL07511751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical