Provider Demographics
NPI:1578122792
Name:FANNING, KRISTEN HAHN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HAHN
Last Name:FANNING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:HAHN
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:29825 WINDCHIME HL
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4589
Mailing Address - Country:US
Mailing Address - Phone:817-456-8039
Mailing Address - Fax:
Practice Address - Street 1:28604 INTERSTATE 10 W UNIT 8
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9115
Practice Address - Country:US
Practice Address - Phone:830-755-8853
Practice Address - Fax:830-755-8875
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist