Provider Demographics
NPI:1992216238
Name:HANNA, GRETCHEN JANE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JANE
Last Name:HANNA
Suffix:
Gender:F
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 1:15518 27TH DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4844
Mailing Address - Country:US
Mailing Address - Phone:425-879-0342
Mailing Address - Fax:
Practice Address - Street 1:1601 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1718
Practice Address - Country:US
Practice Address - Phone:360-563-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60789352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist