MEDICARE: HANNAH BULTHUIS MS, CF-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242006815	IL

General Provider Information

NPI Number	:	1386372142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BULTHUIS MS, CF-SLP

Provider Business Mailing Address
First Line	:	2317 GRAY HAWK DR
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-6568
Country	:	US
Telephone Number	:	815-582-0424
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 GRAY HAWK DR
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-6568
Country	:	US
Telephone Number	:	815-582-0424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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