Provider Demographics
NPI:1295407518
Name:WHEELER, HANNAH GRACE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:GRACE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:GRACE
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:198 OLD SYMSONIA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025
Mailing Address - Country:US
Mailing Address - Phone:270-533-3087
Mailing Address - Fax:
Practice Address - Street 1:1710 KY 121
Practice Address - Street 2:SUITE K
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-767-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY279229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY273133OtherKENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY
KY7100882970Medicaid
KY279229OtherKENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY