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General NPI Number Information
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NPI Number | 1730600073
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Entity Type | Individual
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Provider Name | HANNAH ELIZABETH MIEDEMA MA
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Gender | Female
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 500 LEMOYNE RD
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City | NORTHWOOD
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State | OH
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Zip | 43619-1810
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Country | US
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Telephone | 419-691-3888
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Fax |
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Provider Business Mailing Address
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Address Line | 28875 GEORGIA RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-3629
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Country | US
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Telephone | 419-376-4089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.12230
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License Number State | OH
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