Healthcare Provider Details

I. General information

NPI: 1649304106
Provider Name (Legal Business Name): PAMELA HANNA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SANGER AVE
WACO TX
76710-5866
US

IV. Provider business mailing address

2110 W 3RD ST
CLIFTON TX
76634-1138
US

V. Phone/Fax

Practice location:
  • Phone: 254-848-6284
  • Fax: 254-848-4193
Mailing address:
  • Phone: 254-498-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: