Provider Demographics
NPI:1821541327
Name:RACINE, HANNAH (MS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:RACINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 LAKE HAVEN SQ UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6095
Mailing Address - Country:US
Mailing Address - Phone:813-597-7930
Mailing Address - Fax:
Practice Address - Street 1:7243 US 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8399
Practice Address - Country:US
Practice Address - Phone:813-663-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist