MEDICARE: MS. ANNETTE RENI HANLEY MS CCC 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	3209	OK

General Provider Information

NPI Number	:	1972680965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNETTE RENI HANLEY MS CCC SLP

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557-0043
Country	:	US
Telephone Number	:	405-826-7852
Fax Number	:	580-606-6397

Provider Business Practice Location Address
First Line	:	261 EAST LAKE DRIVE
Second Line	:
City	:	MEDICINE PARK
State	:	OK
Zip	:	73557
Country	:	US
Telephone Number	:	405-826-7852
Fax Number	:	405-606-6397

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/13/2019

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