Provider Demographics
NPI:1104335330
Name:HANNAH, KALEE
Entity type:Individual
Prefix:
First Name:KALEE
Middle Name:
Last Name:HANNAH
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 1:312 FOSSIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-7034
Mailing Address - Country:US
Mailing Address - Phone:719-659-7116
Mailing Address - Fax:
Practice Address - Street 1:2989 BROADMOOR VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4403
Practice Address - Country:US
Practice Address - Phone:719-576-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician