Healthcare Provider Details

I. General information

NPI: 1700172079
Provider Name (Legal Business Name): MRS. CATARINA HANNA II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SCHOOL DISTRICT RD CANAJOHARIE ELEMENTARY SCHOOL
CANAJOHARIE NY
13317-1542
US

IV. Provider business mailing address

142 GOODEMOTE RD
BROADALBIN NY
12025-1756
US

V. Phone/Fax

Practice location:
  • Phone: 581-673-6300
  • Fax:
Mailing address:
  • Phone: 518-883-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016900-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: