Provider Demographics
NPI:1013350545
Name:HANNA, CANDACE R (MA-CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:R
Last Name:HANNA
Suffix:
Gender:F
Credentials:MA-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E 70TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2542
Mailing Address - Country:US
Mailing Address - Phone:816-739-9094
Mailing Address - Fax:
Practice Address - Street 1:314 E 70TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2542
Practice Address - Country:US
Practice Address - Phone:816-739-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist