Healthcare Provider Details

I. General information

NPI: 1669392080
Provider Name (Legal Business Name): HANNAH CLEMENTS MIZELLE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS HANNAH NOELLE CLEMENTS

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 HUSKY TRL
TARBORO NC
27886-3382
US

IV. Provider business mailing address

7454 VAUGHAN CHAPEL RD
ELM CITY NC
27822-8095
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-0464
  • Fax: 252-641-1816
Mailing address:
  • Phone: 252-641-0464
  • Fax: 252-641-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30001809
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: