Provider Demographics
NPI:1730659145
Name:DORNBUSCH, HANNAH S JR
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:S
Last Name:DORNBUSCH
Suffix:JR
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 1:1255 HARRISON ST APT 226
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5994
Mailing Address - Country:US
Mailing Address - Phone:413-824-2810
Mailing Address - Fax:
Practice Address - Street 1:1255 HARRISON ST APT 226
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5994
Practice Address - Country:US
Practice Address - Phone:413-824-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMC61009955101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program