Provider Demographics
NPI:1225847841
Name:WITTMAN, HANNAH ELISE (MA, CFY-SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELISE
Last Name:WITTMAN
Suffix:
Gender:F
Credentials:MA, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2603
Mailing Address - Country:US
Mailing Address - Phone:618-402-9758
Mailing Address - Fax:
Practice Address - Street 1:211 DORA RENO WHITE ST
Practice Address - Street 2:
Practice Address - City:SHIPMAN
Practice Address - State:IL
Practice Address - Zip Code:62685-4229
Practice Address - Country:US
Practice Address - Phone:618-836-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist