Provider Demographics
NPI:1366880320
Name:HANSON, MICHELLE SUZANNE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 19TH ST E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3470
Mailing Address - Country:US
Mailing Address - Phone:910-616-6559
Mailing Address - Fax:
Practice Address - Street 1:683 STATE AVE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4660
Practice Address - Country:US
Practice Address - Phone:701-483-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist