=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467223545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH ELSA ABRAHAM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2024
-----------------------------------------------------
Last Update Date | 01/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3415 LINCOLN BLVD SW
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98439-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-970-7408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5510 82ND ST SW APT J205
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-6435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-970-7408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SI61462365
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------