Provider Demographics
NPI:1003042508
Name:HANNAH, SAMANTHA LONETTA RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LONETTA RAE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:LONETTA RAE
Other - Last Name:KIMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:8921 SOUTHPOINTE DR
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1084
Mailing Address - Country:US
Mailing Address - Phone:317-881-1718
Mailing Address - Fax:317-881-1728
Practice Address - Street 1:8921 SOUTHPOINTE DR
Practice Address - Street 2:SUITE C-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1084
Practice Address - Country:US
Practice Address - Phone:317-881-1718
Practice Address - Fax:317-881-1728
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003994A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist