Provider Demographics
NPI:1336641026
Name:HANNAH, DAVID T
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:HANNAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TAYLOR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7739
Mailing Address - Country:US
Mailing Address - Phone:208-322-1111
Mailing Address - Fax:
Practice Address - Street 1:1100 TAYLOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7739
Practice Address - Country:US
Practice Address - Phone:208-322-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist