Provider Demographics
NPI:1275865180
Name:DITMARS BUCKWALTER, HANNAH A (AUD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:A
Last Name:DITMARS BUCKWALTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:A
Other - Last Name:DITMARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 830738
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0731
Mailing Address - Country:US
Mailing Address - Phone:402-472-2071
Mailing Address - Fax:402-472-3814
Practice Address - Street 1:3835 HOLDREGE STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0731
Practice Address - Country:US
Practice Address - Phone:402-472-2071
Practice Address - Fax:402-472-3814
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE279231H00000X
NE102237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE102OtherHEARING INSTRUMENT SPECIALIST/A
NE279OtherNEBRASKA STATE AUDIOLOGY LICENSE