Provider Demographics
NPI:1023367646
Name:HANSEN, AMANDA ELAINE (BS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 EAST AZURE AVE.
Mailing Address - Street 2:#3040
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-9016
Mailing Address - Country:US
Mailing Address - Phone:509-551-6888
Mailing Address - Fax:
Practice Address - Street 1:1333 N BUFFALO DR UNIT 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3637
Practice Address - Country:US
Practice Address - Phone:702-979-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X, 235Z00000X
NVSP-3128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant