Provider Demographics
NPI:1891134284
Name:HAHN, MELISSA ANN (CMT, CR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HAHN
Suffix:
Gender:F
Credentials:CMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1413
Mailing Address - Country:US
Mailing Address - Phone:763-684-4646
Mailing Address - Fax:
Practice Address - Street 1:109 2ND ST S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1413
Practice Address - Country:US
Practice Address - Phone:763-684-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist