Provider Demographics
NPI:1124330691
Name:HANOVER, FERN HEIDI (MA, MED, MS)
Entity type:Individual
Prefix:MISS
First Name:FERN
Middle Name:HEIDI
Last Name:HANOVER
Suffix:
Gender:F
Credentials:MA, MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 W 86TH ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3139
Mailing Address - Country:US
Mailing Address - Phone:212-933-1640
Mailing Address - Fax:212-933-1640
Practice Address - Street 1:320 W 86TH ST
Practice Address - Street 2:APT. 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3139
Practice Address - Country:US
Practice Address - Phone:917-648-1787
Practice Address - Fax:212-933-1640
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009473-1235Z00000X
NJ41YS00596100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist