Provider Demographics
NPI:1417336223
Name:HANNA, AMANDA ROSE (LCSW, CSAC, PMH-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:HANNA
Suffix:
Gender:F
Credentials:LCSW, CSAC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9588
Mailing Address - Country:US
Mailing Address - Phone:608-239-3975
Mailing Address - Fax:
Practice Address - Street 1:2422 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6105
Practice Address - Country:US
Practice Address - Phone:262-549-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16234-132101YA0400X
WI8943-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)