Provider Demographics
NPI:1265165658
Name:DEWALT, HANNAH MARIE
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:MARIE
Last Name:DEWALT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:MARIE
Other - Last Name:BOSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1029
Mailing Address - Country:US
Mailing Address - Phone:330-831-6943
Mailing Address - Fax:
Practice Address - Street 1:165 E PARK AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2352
Practice Address - Country:US
Practice Address - Phone:330-544-8005
Practice Address - Fax:330-544-9379
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator