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NPI Code Detail

MEDICARE: MRS. KENDALL JORDAN HANNAH

MEDICARE: MRS. KENDALL JORDAN HANNAH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA17867FL

General Provider Information

NPI Number : 1922615277
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KENDALL JORDAN HANNAH
Provider Business Mailing Address
First Line : 258 SW ROBINSON CT
Second Line :
City : LAKE CITY
State : FL
Zip : 32024-4193
Country : US
Telephone Number : 386-590-3411
Fax Number :
Provider Business Practice Location Address
First Line : 1620 HELVENSTON ST SE
Second Line :
City : LIVE OAK
State : FL
Zip : 32064-3474
Country : US
Telephone Number : 386-590-3411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2020
Last Update Date : 09/29/2020

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Directions to “ MRS. KENDALL JORDAN HANNAH ” Practice Location

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