Provider Demographics
NPI:1659099679
Name:MAHAFFEY, HANNAH (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 PRESIDENT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3749
Mailing Address - Country:US
Mailing Address - Phone:512-680-9391
Mailing Address - Fax:
Practice Address - Street 1:702 PRESIDENT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3749
Practice Address - Country:US
Practice Address - Phone:512-680-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0655730-01Medicaid