Provider Demographics
NPI:1386372142
Name:BULTHUIS, HANNAH (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BULTHUIS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 GRAY HAWK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6568
Mailing Address - Country:US
Mailing Address - Phone:815-582-0424
Mailing Address - Fax:
Practice Address - Street 1:2317 GRAY HAWK DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-6568
Practice Address - Country:US
Practice Address - Phone:815-582-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist