Provider Demographics
NPI:1497217897
Name:HANNA, GRACE ELEXANDRA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELEXANDRA
Last Name:HANNA
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 RUNNING DEER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3038
Mailing Address - Country:US
Mailing Address - Phone:512-466-4713
Mailing Address - Fax:
Practice Address - Street 1:801 S ENNIS ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4642
Practice Address - Country:US
Practice Address - Phone:979-209-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115096Medicaid