Basic Information
| Provider Information | |||||||||
| NPI: | 1134557408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLYSTONE | ||||||||
| FirstName: | HANNA | ||||||||
| MiddleName: | GRATZMILLER | ||||||||
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| Credential: | MS,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 IRMC DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129524877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243577000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 12/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL011321 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.