Provider Demographics
NPI:1811609134
Name:JOHNSON, HANNAH J (SAC-IT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E BADGER RD STE A
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2726
Mailing Address - Country:US
Mailing Address - Phone:608-250-2512
Mailing Address - Fax:
Practice Address - Street 1:151 E BADGER RD STE A
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-2726
Practice Address - Country:US
Practice Address - Phone:608-250-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20118-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)