Provider Demographics
NPI:1073733382
Name:HANSON, CHERIE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:
Other - Last Name:GILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-0725
Mailing Address - Country:US
Mailing Address - Phone:210-357-0300
Mailing Address - Fax:830-709-5493
Practice Address - Street 1:19965 FM 3175
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3481
Practice Address - Country:US
Practice Address - Phone:210-357-0300
Practice Address - Fax:830-709-5493
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104872OtherTEXAS DEPT. OF STATE HEALTH SERVICE LICENSING BOARD