Provider Demographics
NPI:1841779550
Name:HANLON, MATTHEW JOHN (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:HANLON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 BLAIRS FERRY RD NE STE 600
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5892
Mailing Address - Country:US
Mailing Address - Phone:319-440-0524
Mailing Address - Fax:319-409-8071
Practice Address - Street 1:1957 BLAIRS FERRY RD NE STE 600
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5892
Practice Address - Country:US
Practice Address - Phone:319-440-0524
Practice Address - Fax:319-409-8071
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health