| Doctor Name: | SCOTT HANNEMAN |
| NPI Number: | 1043608037 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D., L.P |
| License Number: | 5855 |
| Business Practice Address: | 3525 Monterey Dr St Louis Park, MN - 554165275 |
| Business Phone Number: | 9529936200 |
| Business Fax Number: | 9529935599 |
| Mailing Address: | 3525 Monterey Dr, ST LOUIS PARK |
| State: | MN |
| Postal Code: | 554165275 |
| Phone Number: | 9529936200 |
| Fax Number: | |
| NPI Enumeration Date: | 12/30/2014 |
| NPI Last Update Date: | 12/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 5855 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |