Provider Demographics
NPI:1669713186
Name:HANNO, JENNIE LYNN (SAC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYNN
Last Name:HANNO
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S BARSTOW ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3642
Mailing Address - Country:US
Mailing Address - Phone:715-855-1373
Mailing Address - Fax:715-855-1375
Practice Address - Street 1:122 S BARSTOW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3642
Practice Address - Country:US
Practice Address - Phone:715-855-1373
Practice Address - Fax:715-855-1375
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15627-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)