Provider Demographics
NPI:1194261552
Name:ROSE, HANNAH (LCSW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:ROSE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:182 SW ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1996
Mailing Address - Country:US
Mailing Address - Phone:503-623-9289
Mailing Address - Fax:503-361-2664
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-361-2664
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097882104100000X
1041C0700X
ORL8233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid