Provider Demographics
NPI:1396570313
Name:BIRD, HANNAH BRAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:BRAY
Last Name:BIRD
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 1:262 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2344
Mailing Address - Country:US
Mailing Address - Phone:304-550-7105
Mailing Address - Fax:
Practice Address - Street 1:3819 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2647
Practice Address - Country:US
Practice Address - Phone:304-925-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist