Provider Demographics
NPI:1427090075
Name:HANKE, KRISTIANA MICHELLE (SLP)
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:MICHELLE
Last Name:HANKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:MICHELLE
Other - Last Name:HANKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:11501 POOLSIDE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4534
Mailing Address - Country:US
Mailing Address - Phone:502-439-6922
Mailing Address - Fax:
Practice Address - Street 1:11501 POOLSIDE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4534
Practice Address - Country:US
Practice Address - Phone:502-439-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2873235Z00000X
KY142057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9715Medicare ID - Type Unspecified