Provider Demographics
NPI:1023748126
Name:HANSEN, STEPHANIE RENEE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:BIXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 TRAILHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5719
Mailing Address - Country:US
Mailing Address - Phone:214-908-8045
Mailing Address - Fax:
Practice Address - Street 1:350 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2249
Practice Address - Country:US
Practice Address - Phone:817-744-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist