Provider Demographics
NPI:1033992367
Name:HARRELL, HANNAH RAE (CFY - SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:RAE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:CFY - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1871
Mailing Address - Country:US
Mailing Address - Phone:903-908-1302
Mailing Address - Fax:
Practice Address - Street 1:4241 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2794
Practice Address - Country:US
Practice Address - Phone:903-793-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist