Provider Demographics
NPI:1972266039
Name:PHELPS, HANNAH JEANETTE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:JEANETTE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:HP
Other - Middle Name:
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:16720 REDMOND WAY STE G
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16720 REDMOND WAY STE G
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4484
Practice Address - Country:US
Practice Address - Phone:206-486-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61374916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL61374916OtherSPEECH LANGUAGE PATHOLOGIST LICENSE