Provider Demographics
NPI:1386410876
Name:HAEDIKE-SWIFT, HANNAH SHAE (MA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:SHAE
Last Name:HAEDIKE-SWIFT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:SHAE
Other - Last Name:HAEDIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:822 4TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-2399
Mailing Address - Country:US
Mailing Address - Phone:636-577-9819
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD BLDG 2101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3196
Practice Address - Country:US
Practice Address - Phone:970-484-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health