Provider Demographics
NPI:1003851585
Name:HANRAHAN, AMANDA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6651
Mailing Address - Country:US
Mailing Address - Phone:918-684-3700
Mailing Address - Fax:918-684-3724
Practice Address - Street 1:202 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6651
Practice Address - Country:US
Practice Address - Phone:918-684-3700
Practice Address - Fax:918-684-3724
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLP 3111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200063990CMedicaid