Provider Demographics
NPI:1669949236
Name:HANNAH, CAMERON RAE (MS)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:RAE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RAE
Other - Last Name:HANNAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5317 S PALOUSE HWY APT G150
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7802
Mailing Address - Country:US
Mailing Address - Phone:303-319-5882
Mailing Address - Fax:
Practice Address - Street 1:905 W RIVERSIDE AVE STE 214
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1099
Practice Address - Country:US
Practice Address - Phone:509-589-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60839250101Y00000X, 101YM0800X
WALH61163880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor