Provider Demographics
NPI:1447931589
Name:VAN DYKE, HANNAH THERESE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:THERESE
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:THERESE
Other - Last Name:MCCALLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82324 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6057
Mailing Address - Country:US
Mailing Address - Phone:503-358-2489
Mailing Address - Fax:
Practice Address - Street 1:4537 SW 96TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3329
Practice Address - Country:US
Practice Address - Phone:503-376-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health