Provider Demographics
NPI:1043275365
Name:HAHN, SHELLY E (MA,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:E
Last Name:HAHN
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1102
Mailing Address - Country:US
Mailing Address - Phone:610-649-8255
Mailing Address - Fax:610-649-2924
Practice Address - Street 1:626 HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1102
Practice Address - Country:US
Practice Address - Phone:610-649-8255
Practice Address - Fax:610-649-2924
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000963L235Z00000X
PASL-000963-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2996OtherAETNA
PA0701755000OtherINDEPENDENCE BL
PA758387OtherHIGHMARK BC/BS