Provider Demographics
NPI:1588239222
Name:HAHN, CHERYL RENEE (CRSS)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:RENEE
Last Name:HAHN
Suffix:
Gender:F
Credentials:CRSS
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:RENEE
Other - Last Name:FARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRSS
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9637
Practice Address - Country:US
Practice Address - Phone:815-756-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31610175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist