Provider Demographics
NPI:1649304106
Name:HANNA, PAMELA (SLP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1138
Mailing Address - Country:US
Mailing Address - Phone:254-498-4970
Mailing Address - Fax:
Practice Address - Street 1:4900 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5866
Practice Address - Country:US
Practice Address - Phone:254-848-6284
Practice Address - Fax:254-848-4193
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211226001Medicaid