Provider Demographics
NPI:1871750935
Name:HANSON, SARAH ELIZABETH (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 FARM LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5874
Mailing Address - Country:US
Mailing Address - Phone:843-304-6259
Mailing Address - Fax:
Practice Address - Street 1:29 PLANTATION PARK DR
Practice Address - Street 2:SUITE 403
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-815-6999
Practice Address - Fax:843-815-6998
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1093Medicaid