Provider Demographics
NPI:1316282650
Name:HANNING, SARA SASHA (LAC, LMT)
Entity type:Individual
Prefix:
First Name:SARA SASHA
Middle Name:
Last Name:HANNING
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 N WOLCOTT AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3535
Mailing Address - Country:US
Mailing Address - Phone:858-337-3639
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST
Practice Address - Street 2:SUITE 530
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5373
Practice Address - Country:US
Practice Address - Phone:312-787-7850
Practice Address - Fax:312-787-7853
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist