Provider Demographics
NPI:1730600073
Name:MIEDEMA, HANNAH ELIZABETH (MA)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:MIEDEMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:ELIZABETH
Other - Last Name:SCHOOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:28875 GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3629
Mailing Address - Country:US
Mailing Address - Phone:419-376-4089
Mailing Address - Fax:
Practice Address - Street 1:500 LEMOYNE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1810
Practice Address - Country:US
Practice Address - Phone:419-691-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist