Provider Demographics
NPI:1164005211
Name:ROSE, HANNAH LEE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:IN
Mailing Address - Zip Code:47040-1146
Mailing Address - Country:US
Mailing Address - Phone:812-907-0274
Mailing Address - Fax:
Practice Address - Street 1:405 RIO VISTA LN
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-9497
Practice Address - Country:US
Practice Address - Phone:812-907-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003820A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist