Provider Demographics
NPI:1134722861
Name:BLACK, HANNAH REBECCA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:REBECCA
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:REBECCA
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 W CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4264
Mailing Address - Country:US
Mailing Address - Phone:256-259-1505
Mailing Address - Fax:
Practice Address - Street 1:412 W CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4264
Practice Address - Country:US
Practice Address - Phone:256-259-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist