Provider Demographics
NPI:1659859254
Name:HANNON, NOELLE LOUISE (MS-SLP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LOUISE
Last Name:HANNON
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 HUMMINGBIRD HILL DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5802
Mailing Address - Country:US
Mailing Address - Phone:724-971-5799
Mailing Address - Fax:
Practice Address - Street 1:1903 CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1809
Practice Address - Country:US
Practice Address - Phone:330-744-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.13142Medicaid