Healthcare Provider Details

I. General information

NPI: 1326887506
Provider Name (Legal Business Name): HANNAH DIANE WYCOFF M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH KAUAIHILO

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E UNIVERSITY AVE
GEORGETOWN TX
78626-6826
US

IV. Provider business mailing address

2112 PECAN ISLAND DR
LEANDER TX
78641-4331
US

V. Phone/Fax

Practice location:
  • Phone: 512-943-5000
  • Fax:
Mailing address:
  • Phone: 252-207-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122280
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: