Provider Demographics
NPI:1366682528
Name:HANNASCH, JENNIFER (SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANNASCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23813 474TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-6123
Mailing Address - Country:US
Mailing Address - Phone:605-359-7786
Mailing Address - Fax:605-428-4689
Practice Address - Street 1:23813 474TH AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-6123
Practice Address - Country:US
Practice Address - Phone:605-359-7786
Practice Address - Fax:605-428-4689
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD09139364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist