MEDICARE: HANNAH R DOHERTY

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	120505	TX

General Provider Information

NPI Number	:	1871276030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH R DOHERTY

Provider Business Mailing Address
First Line	:	847 E ASHBY PL APT 480
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2047
Country	:	US
Telephone Number	:	609-605-7394
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 E ASHBY PL APT 480
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2047
Country	:	US
Telephone Number	:	609-605-7394
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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Directions to “ HANNAH R DOHERTY ” Practice Location

Language	Start Address	Practice Location

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