Provider Demographics
NPI:1831869304
Name:RUDECK, HANNAH
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:
Last Name:RUDECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8065 S OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:LK NEBAGAMON
Mailing Address - State:WI
Mailing Address - Zip Code:54849-9018
Mailing Address - Country:US
Mailing Address - Phone:218-256-0004
Mailing Address - Fax:
Practice Address - Street 1:4140 RICHARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-3309
Practice Address - Country:US
Practice Address - Phone:218-514-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician