Provider Demographics
NPI:1891127833
Name:HANNA, BRIDGET (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3414
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-3414
Mailing Address - Country:US
Mailing Address - Phone:406-396-6197
Mailing Address - Fax:
Practice Address - Street 1:129 W KENT AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6730
Practice Address - Country:US
Practice Address - Phone:406-396-6197
Practice Address - Fax:888-974-8690
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-10411041C0700X
MT10411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty