Provider Demographics
NPI:1295599330
Name:BASKA, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BASKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16802 KEASEY RD
Mailing Address - Street 2:
Mailing Address - City:VERNONIA
Mailing Address - State:OR
Mailing Address - Zip Code:97064-9439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16802 KEASEY RD
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-9439
Practice Address - Country:US
Practice Address - Phone:971-269-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst