Provider Demographics
NPI:1437698073
Name:HANSON, STEPHANIE ALLYCE (HIS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLYCE
Last Name:HANSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W57N709 HAWTHORNE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1460
Mailing Address - Country:US
Mailing Address - Phone:414-940-4024
Mailing Address - Fax:
Practice Address - Street 1:11030 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5009
Practice Address - Country:US
Practice Address - Phone:262-240-0288
Practice Address - Fax:262-240-0503
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1496-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist