Provider Demographics
NPI:1861161762
Name:WOODY, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WOODY
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 1:4110 EATON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1702
Mailing Address - Country:US
Mailing Address - Phone:208-402-5735
Mailing Address - Fax:855-353-0026
Practice Address - Street 1:4110 EATON AVE STE B
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1702
Practice Address - Country:US
Practice Address - Phone:208-402-5735
Practice Address - Fax:855-353-0026
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-4968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist