Individual
DEIDRE MICHELE HANNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
2001 S OAK ST STE B, CHAMPAIGN, IL 61820-0912
(217) 244-1806
Mailing address
2001 S OAK ST STE B, CHAMPAIGN, IL 61820-0912
(217) 244-1806
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1095903
WI
235Z00000X
Speech-Language Pathologist
Primary
3288
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1095903
BACB
IL
01
—
147140
STATE OF WISCONSIN
WI
01
—
3288
STATE SLP LICENSE
NM
Enumeration date
08/31/2006
Last updated
04/30/2021
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