Provider Demographics
NPI:1043975824
Name:HANNA, NADENE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:NADENE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6826
Mailing Address - Country:US
Mailing Address - Phone:512-943-5000
Mailing Address - Fax:512-943-5004
Practice Address - Street 1:507 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6826
Practice Address - Country:US
Practice Address - Phone:512-943-5000
Practice Address - Fax:512-943-5004
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065985601Medicaid