Provider Demographics
NPI:1689496986
Name:REPP, HANNAH RUTH (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:RUTH
Last Name:REPP
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:DR
Other - First Name:HANNAH
Other - Middle Name:RUTH
Other - Last Name:GODBOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:722 SOUTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:651-210-5535
Mailing Address - Fax:
Practice Address - Street 1:722 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:651-210-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical