Provider Demographics
NPI:1851687040
Name:HANNEMAN, SCOTT ROBERT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:HANNEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 BELLA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2648
Mailing Address - Country:US
Mailing Address - Phone:719-623-9717
Mailing Address - Fax:
Practice Address - Street 1:4615 BELLA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2648
Practice Address - Country:US
Practice Address - Phone:719-623-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health