Provider Demographics
NPI:1164733127
Name:CANNON, HANNAH LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEE
Last Name:CANNON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:LEE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1201 BURLEYSON RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3019
Mailing Address - Country:US
Mailing Address - Phone:706-226-8900
Mailing Address - Fax:706-226-8905
Practice Address - Street 1:1201 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3019
Practice Address - Country:US
Practice Address - Phone:706-226-8900
Practice Address - Fax:706-226-8905
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN004227235Z00000X
GA007318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist