Provider Demographics
NPI:1508404955
Name:HUMPHREY, HANNAH RAE (SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:RAE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ARMOUR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4706
Mailing Address - Country:US
Mailing Address - Phone:601-750-1142
Mailing Address - Fax:
Practice Address - Street 1:3850 E ESTHER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2009
Practice Address - Country:US
Practice Address - Phone:562-498-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist