Provider Demographics
NPI:1720406309
Name:WATERMAN, HANNAH (LICSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:DUMMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 W 2ND ST STE 448
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1920
Mailing Address - Country:US
Mailing Address - Phone:218-269-3119
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST STE 448
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1920
Practice Address - Country:US
Practice Address - Phone:218-269-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116011041C0700X
MN230341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1720406309Medicaid
MN1720406309Medicaid