| Doctor Name: | MR. GARY HANNEMANN |
| NPI Number: | 1063443091 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2624-125 |
| Business Practice Address: | 75 S Pagosa Blvd Pagosa Springs, CO - 811477910 |
| Business Phone Number: | 9709462540 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2601, PAGOSA SPRINGS |
| State: | CO |
| Postal Code: | 811472601 |
| Phone Number: | 9707316140 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2624-125 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |