Provider Demographics
NPI:1871372292
Name:WENTWORTH, HANNAH JORDAN
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:JORDAN
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:JORDAN
Other - Last Name:NIEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3128 E 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4728
Mailing Address - Country:US
Mailing Address - Phone:509-724-3790
Mailing Address - Fax:
Practice Address - Street 1:1720 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2474
Practice Address - Country:US
Practice Address - Phone:866-240-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician