1043275365 NPI number — SHELLY E. HAHN MA,CCC/SLP

Table of content: SHELLY E. HAHN MA,CCC/SLP (NPI 1043275365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043275365 NPI number — SHELLY E. HAHN MA,CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAHN
Provider First Name:
SHELLY
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043275365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
626 HAVERFORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19041-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-649-8255
Provider Business Mailing Address Fax Number:
610-649-2924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
626 HAVERFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19041-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-8255
Provider Business Practice Location Address Fax Number:
610-649-2924
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL000963L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SL-000963-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2996 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0701755000 . This is a "INDEPENDENCE BL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 758387 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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