Provider Demographics
NPI:1194487322
Name:GRILLS, HANNAH
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GRILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 S NETTLETON AVE APT C207
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5974
Mailing Address - Country:US
Mailing Address - Phone:417-293-0288
Mailing Address - Fax:
Practice Address - Street 1:209 S SHILOH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MO
Practice Address - Zip Code:65632-8238
Practice Address - Country:US
Practice Address - Phone:417-589-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2021038527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist