Provider Demographics
NPI:1205913803
Name:HANNAM, SUSAN ELIZABETH (HSD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:HANNAM
Suffix:
Gender:F
Credentials:HSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:232 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1151
Mailing Address - Country:US
Mailing Address - Phone:724-794-3931
Mailing Address - Fax:724-738-2881
Practice Address - Street 1:1 MORROW WAY
Practice Address - Street 2:SLIPPERY ROCK UNIVERSITY
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1313
Practice Address - Country:US
Practice Address - Phone:724-738-2794
Practice Address - Fax:724-738-2881
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000441A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPROVIDER CODE 22OtherPROVIDER CODE 22