Provider Demographics
NPI:1285013185
Name:FULLER, HANNAH (MA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:GONYEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 BATTLECREEK DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-5120
Mailing Address - Country:US
Mailing Address - Phone:970-221-1201
Mailing Address - Fax:
Practice Address - Street 1:651 S STATE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2552
Practice Address - Country:US
Practice Address - Phone:317-736-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist