Basic Information
Provider Information
NPI: 1205450350
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARNOLD
FirstName: HANNAH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12110 CLAYTON RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631312516
CountryCode: US
TelephoneNumber: 3149898150
FaxNumber:  
Practice Location
Address1: 1227 N MAIN ST
Address2:  
City: MIAMI
State: OK
PostalCode: 743543322
CountryCode: US
TelephoneNumber: 9185426655
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2020
LastUpdateDate: 07/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X  N Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
235Z00000X2020017786MOY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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