Provider Demographics
NPI:1770059610
Name:AMMONS, HANNA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:AMMONS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:SODERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2205 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2970
Mailing Address - Country:US
Mailing Address - Phone:734-998-3497
Mailing Address - Fax:
Practice Address - Street 1:2205 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2970
Practice Address - Country:US
Practice Address - Phone:734-998-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty