MEDICARE: KERRA HANKE

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
2	235Z00000X	Speech-Language Pathologist	SL013227	PA

General Provider Information

NPI Number	:	1720538762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRA HANKE

Provider Business Mailing Address
First Line	:	1225 S BUCKNELL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4120
Country	:	US
Telephone Number	:	732-556-7597
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 ABBOTT DR UNIT 2
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-4323
Country	:	US
Telephone Number	:	844-244-1818
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	08/27/2021

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Directions to “ KERRA HANKE ” Practice Location

Language	Start Address	Practice Location

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