Provider Demographics
NPI:1104510460
Name:WIDGER, HANNAH GRACE (LCSWA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:WIDGER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 TESLA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3236
Mailing Address - Country:US
Mailing Address - Phone:719-493-4895
Mailing Address - Fax:
Practice Address - Street 1:43 COLLEGE PL STE 210
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2792
Practice Address - Country:US
Practice Address - Phone:828-255-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0190131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical