Provider Demographics
NPI:1790645695
Name:BOLDT, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BOLDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-2800
Mailing Address - Country:US
Mailing Address - Phone:815-990-4815
Mailing Address - Fax:
Practice Address - Street 1:1386 KIWANIS DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6908
Practice Address - Country:US
Practice Address - Phone:815-990-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.008252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist