Provider Demographics
NPI:1174852636
Name:HANSEN, ADRIENNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
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 1:1000 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4242
Mailing Address - Country:US
Mailing Address - Phone:479-631-7678
Mailing Address - Fax:479-631-8886
Practice Address - Street 1:1000 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4242
Practice Address - Country:US
Practice Address - Phone:479-631-7678
Practice Address - Fax:479-631-8886
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist