Provider Demographics
NPI:1922121086
Name:HAHN, CONNIE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:C
Last Name:HAHN
Suffix:
Gender:F
Credentials:PHD
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 177
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:ID
Mailing Address - Zip Code:83839-0177
Mailing Address - Country:US
Mailing Address - Phone:208-682-3532
Mailing Address - Fax:208-682-9952
Practice Address - Street 1:135 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2567
Practice Address - Country:US
Practice Address - Phone:208-786-7040
Practice Address - Fax:208-682-9952
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist