Provider Demographics
NPI:1902557044
Name:HAYNES, HANNAH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HAYNES
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 1:125 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-2702
Mailing Address - Country:US
Mailing Address - Phone:717-571-7687
Mailing Address - Fax:
Practice Address - Street 1:1801 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4011
Practice Address - Country:US
Practice Address - Phone:717-571-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE14421439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0Medicaid