Provider Demographics
NPI:1720746589
Name:HAHN, ELLIESHA (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELLIESHA
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 EXCELSIOR BLVD STE 134
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3049
Mailing Address - Country:US
Mailing Address - Phone:952-925-0109
Mailing Address - Fax:952-285-4103
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 134
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3049
Practice Address - Country:US
Practice Address - Phone:612-963-4242
Practice Address - Fax:952-285-4103
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health