Provider Demographics
NPI:1871713560
Name:HANSON, ELIZABETH KAY (PHD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E CLARK ST
Mailing Address - Street 2:COMMUNICATION DISORDERS
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2307
Mailing Address - Country:US
Mailing Address - Phone:605-677-5475
Mailing Address - Fax:605-677-5767
Practice Address - Street 1:414 E CLARK ST
Practice Address - Street 2:COMMUNICATION DISORDERS
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2307
Practice Address - Country:US
Practice Address - Phone:605-677-5475
Practice Address - Fax:605-677-5767
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist