Provider Demographics
NPI:1063887800
Name:JACKSON, HANNAH DUNNACK (MS)
Entity type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:DUNNACK
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 FARMINGTON AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2162
Mailing Address - Country:US
Mailing Address - Phone:860-888-7040
Mailing Address - Fax:
Practice Address - Street 1:998 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2162
Practice Address - Country:US
Practice Address - Phone:860-888-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health