Provider Demographics
NPI:1295407518
Name:TRAVIS, HANNAH GRACE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:GRACE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3280 BLAZER PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2117
Mailing Address - Country:US
Mailing Address - Phone:859-225-5424
Mailing Address - Fax:
Practice Address - Street 1:1710 KY 121
Practice Address - Street 2:SUITE K
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-767-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY273133OtherKENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY
KY279229OtherKENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY