Provider Demographics
NPI:1538639554
Name:GONZALEZ, HANNAH GRACE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:GRACE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 1/2 E ERIE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2050
Mailing Address - Country:US
Mailing Address - Phone:440-787-8144
Mailing Address - Fax:
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1648
Practice Address - Country:US
Practice Address - Phone:440-244-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13396225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH82-5070894OtherINTERNATIONAL REVENUE SERVICE