Provider Demographics
NPI:1932296662
Name:HAHN, CARRIE C (SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:C
Last Name:HAHN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:C
Other - Last Name:CHERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3395 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3765
Mailing Address - Country:US
Mailing Address - Phone:952-939-0396
Mailing Address - Fax:952-548-8760
Practice Address - Street 1:3395 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-939-0396
Practice Address - Fax:952-548-8760
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013007623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12096875OtherCAQH
MO2013007623OtherMISSOURI SPEECH LANGUAGE PATHOLOGY LICENSE