Provider Demographics
NPI:1427845395
Name:BERTHELSON, HANNAH RUTH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RUTH
Last Name:BERTHELSON
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 SAINT NICK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4117
Mailing Address - Country:US
Mailing Address - Phone:901-491-3340
Mailing Address - Fax:
Practice Address - Street 1:3964 GOODMAN RD E STE 105
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8711
Practice Address - Country:US
Practice Address - Phone:662-932-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist