Provider Demographics
NPI:1205461068
Name:HAHN, JUDITH GAIL (NBC-HWC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:GAIL
Last Name:HAHN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 W GREEN TREE ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2704
Mailing Address - Country:US
Mailing Address - Phone:414-736-8899
Mailing Address - Fax:
Practice Address - Street 1:2336 W GREEN TREE ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2704
Practice Address - Country:US
Practice Address - Phone:414-736-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty