Provider Demographics
NPI:1952074312
Name:CHOUTKA, HANNAH ELIZABETH
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:CHOUTKA
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 1:4815 BAY HERON PL APT 617
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2946
Mailing Address - Country:US
Mailing Address - Phone:407-417-5041
Mailing Address - Fax:
Practice Address - Street 1:2111 W SWANN AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2478
Practice Address - Country:US
Practice Address - Phone:224-616-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty