Provider Demographics
NPI:1720188543
Name:HANNA, MARY NEILL (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NEILL
Last Name:HANNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-5115
Mailing Address - Country:US
Mailing Address - Phone:319-338-7884
Mailing Address - Fax:319-338-7006
Practice Address - Street 1:507 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-5115
Practice Address - Country:US
Practice Address - Phone:319-338-7884
Practice Address - Fax:319-338-7006
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
I8038Medicare ID - Type Unspecified