Provider Demographics
NPI:1518410521
Name:ERBACHER, HANNAH LE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LE
Last Name:ERBACHER
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 1:1111 RIDER ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-1042
Mailing Address - Country:US
Mailing Address - Phone:618-335-4711
Mailing Address - Fax:
Practice Address - Street 1:401 W MCMACKIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1724
Practice Address - Country:US
Practice Address - Phone:618-335-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
1-16-24366103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program