Provider Demographics
NPI:1215155189
Name:HANAN, CHERYL LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:HANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14922 SE 58TH ST.
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-452-0801
Mailing Address - Fax:425-635-0405
Practice Address - Street 1:1601 114TH AVE. SE #107
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-452-0801
Practice Address - Fax:425-635-0405
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical