Provider Demographics
NPI:1215283353
Name:HURT, HANNAH (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 LEWIS TURNER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1267
Mailing Address - Country:US
Mailing Address - Phone:850-226-8279
Mailing Address - Fax:
Practice Address - Street 1:1775 LEWIS TURNER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1267
Practice Address - Country:US
Practice Address - Phone:850-226-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11622235Z00000X
TN4538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist