Provider Demographics
NPI:1700950821
Name:HANNON, RACHEL (MED)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DARCEE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7402
Mailing Address - Country:US
Mailing Address - Phone:678-858-4777
Mailing Address - Fax:678-985-3953
Practice Address - Street 1:65 DARCEE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7402
Practice Address - Country:US
Practice Address - Phone:678-858-4777
Practice Address - Fax:678-985-3953
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist