Provider Demographics
NPI:1598434557
Name:GUELLER, HANNAH LUCILLE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LUCILLE
Last Name:GUELLER
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 1:229 8TH AVE SE APT C
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2229
Mailing Address - Country:US
Mailing Address - Phone:414-426-6121
Mailing Address - Fax:
Practice Address - Street 1:1011 MEADOWLANDS DR STE 1&2
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127-2339
Practice Address - Country:US
Practice Address - Phone:612-315-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician