Active NPI
Deidre Michele Hannah, M.A., CCC-SLP
- Speech-Language Pathologist
- Champaign, IL
National Provider Identifier
1518079144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3288
- Practice address
- 2001 S Oak St Ste B
Champaign, IL 61820-0912 - Phone
- (217) 244-1806
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1095903 | WI | |
| Speech-Language Pathologist | 235Z00000X | 3288 | NM | Primary |
Addresses
Primary practice location
2001 S Oak St Ste B
Champaign, IL 61820-0912
Mailing address
2001 S Oak St Ste B
Champaign, IL 61820-0912
Phone (217) 244-1806
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1095903 | Other | IL | BACB |
| 3288 | Other | NM | STATE SLP LICENSE |
| 147140 | Other | WI | STATE OF WISCONSIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1095903 | WI | MD | Behavioral Analyst |
| 3288 | NM | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619740800000",
"number": "1518079144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 S OAK ST STE B",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618200912",
"telephone_number": "217-244-1806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 S OAK ST STE B",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618200912",
"telephone_number": "217-244-1806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNAH",
"first_name": "DEIDRE",
"middle_name": "MICHELE",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2021-04-30",
"certification_date": "2021-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "1095903",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "3288",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BACB",
"identifier": "1095903",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE SLP LICENSE",
"identifier": "3288",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WISCONSIN",
"identifier": "147140",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.