Provider Demographics
NPI:1215351374
Name:TAHHAN-JACKSON, HANNAH (MS, CCC-SLP, BCS-S)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:TAHHAN-JACKSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINESBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 PINESBRIDGE RD
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1300
Practice Address - Country:US
Practice Address - Phone:914-417-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NY2573121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN