Provider Demographics
NPI:1053481614
Name:HANSON, DIANA ELIZABETH (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ELIZABETH
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12499 UNIVERSITY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8281
Mailing Address - Country:US
Mailing Address - Phone:515-418-9960
Mailing Address - Fax:515-418-9107
Practice Address - Street 1:12499 UNIVERSITY AVE
Practice Address - Street 2:STE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8281
Practice Address - Country:US
Practice Address - Phone:515-418-9960
Practice Address - Fax:515-418-9107
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA345231H00000X
IA620237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0414367Medicaid