Provider Demographics
NPI:1710580717
Name:SLIMACK, HANNAH JO
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JO
Last Name:SLIMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 STATE ROUTE 163
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-7743
Mailing Address - Country:US
Mailing Address - Phone:618-604-8398
Mailing Address - Fax:
Practice Address - Street 1:150 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6621
Practice Address - Country:US
Practice Address - Phone:618-235-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist