Provider Demographics
NPI:1205962917
Name:HANNA, JUDITH LYNN (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:HANNA
Suffix:
Gender:F
Credentials:MSW, LSW
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 10310
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0310
Mailing Address - Country:US
Mailing Address - Phone:206-317-4570
Mailing Address - Fax:708-406-1532
Practice Address - Street 1:175 PARFITT WAY SW
Practice Address - Street 2:SUITE N280
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-317-4570
Practice Address - Fax:708-406-1532
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0139491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical