Basic Information
| Provider Information | |||||||||
| NPI: | 1912395971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKMAN | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | R | ||||||||
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| OtherLastName: | MCMEEN | ||||||||
| OtherFirstName: | HANNAH | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 985450 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681985450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596460 | ||||||||
| FaxNumber: | 4025595737 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 S 44TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681313727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596460 | ||||||||
| FaxNumber: | 4025595737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2014 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 453 | NE | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 1793 | NE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.