Basic Information
| Provider Information | |||||||||
| NPI: | 1063667624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNEWALD | ||||||||
| FirstName: | CRISTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805212612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704944300 | ||||||||
| FaxNumber: | 9703469800 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805374804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706647551 | ||||||||
| FaxNumber: | 9705939084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 11/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 849 | CO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.