Provider Demographics
NPI:1508288978
Name:DEAN, HANNAH L
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:L
Last Name:DEAN
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:RR 1 BOX 461
Mailing Address - Street 2:
Mailing Address - City:WESTERN GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72685-9644
Mailing Address - Country:US
Mailing Address - Phone:870-416-9596
Mailing Address - Fax:
Practice Address - Street 1:521 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3518
Practice Address - Country:US
Practice Address - Phone:870-741-2960
Practice Address - Fax:870-741-2960
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health