Provider Demographics
NPI:1114481652
Name:HANSEN, SHERRY LAVON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LAVON
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6951 VIRGINIA PKWY
Mailing Address - Street 2:STE 321
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5860
Mailing Address - Country:US
Mailing Address - Phone:972-768-8941
Mailing Address - Fax:
Practice Address - Street 1:6011 AUTUMN WAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5567
Practice Address - Country:US
Practice Address - Phone:972-768-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist