Provider Demographics
NPI:1760193494
Name:BAKKEN, HANNA (MA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:BAKKEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FOREST GROVE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3894
Mailing Address - Country:US
Mailing Address - Phone:608-778-7190
Mailing Address - Fax:
Practice Address - Street 1:325 FOREST GROVE DR STE 201
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3894
Practice Address - Country:US
Practice Address - Phone:608-778-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10171-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health