Provider Demographics
NPI:1043355324
Name:HANSEN, DANIEL L (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5569
Mailing Address - Country:US
Mailing Address - Phone:319-393-5646
Mailing Address - Fax:319-393-5647
Practice Address - Street 1:3525 CENTER POINT RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5569
Practice Address - Country:US
Practice Address - Phone:319-393-5646
Practice Address - Fax:319-393-5647
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009001289231H00000X
IA274231H00000X
IA503237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2048223Medicaid