Provider Demographics
NPI:1295812105
Name:HANNA, KENNETH LONGFELLOW II (LICSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LONGFELLOW
Last Name:HANNA
Suffix:II
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 DIVISION ST S
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2430
Mailing Address - Country:US
Mailing Address - Phone:320-420-1272
Mailing Address - Fax:320-240-6814
Practice Address - Street 1:807 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2430
Practice Address - Country:US
Practice Address - Phone:320-420-1272
Practice Address - Fax:320-240-6814
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MN134931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical