Provider Demographics
NPI:1750416418
Name:HANNEMANN, VALARIE LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:VALARIE
Middle Name:LOUISE
Last Name:HANNEMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 W GETAWAY TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8569
Mailing Address - Country:US
Mailing Address - Phone:928-214-9187
Mailing Address - Fax:928-214-9187
Practice Address - Street 1:1851 W GETAWAY TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8569
Practice Address - Country:US
Practice Address - Phone:928-214-9187
Practice Address - Fax:928-214-9187
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ22312Medicare ID - Type Unspecified