Provider Demographics
NPI:1558047720
Name:HANNA, JESSICA RUTH (CMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUTH
Last Name:HANNA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:MN
Mailing Address - Zip Code:56026-3070
Mailing Address - Country:US
Mailing Address - Phone:507-402-0654
Mailing Address - Fax:
Practice Address - Street 1:1340 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1800
Practice Address - Country:US
Practice Address - Phone:507-377-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist