Provider Demographics
NPI:1770051963
Name:RODRIGUEZ, HANNA MARIE (MA)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:MARIE
Other - Last Name:PROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 MEADOWCOVE CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2726
Mailing Address - Country:US
Mailing Address - Phone:337-304-6036
Mailing Address - Fax:
Practice Address - Street 1:1738 WYNKOOP ST STE 303
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1000
Practice Address - Country:US
Practice Address - Phone:844-888-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC7622101YP2500X
171M00000X
COLPC.0015599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator