Provider Demographics
NPI:1578035358
Name:LEWALLEN, HANNAH MARIE CAROLINE (SLP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE CAROLINE
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:LEWALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:2300 GALLBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0161
Mailing Address - Country:US
Mailing Address - Phone:704-649-4509
Mailing Address - Fax:704-843-9045
Practice Address - Street 1:2300 GALLBERRY LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0161
Practice Address - Country:US
Practice Address - Phone:704-243-3584
Practice Address - Fax:704-843-9045
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist