Provider Demographics
NPI:1275232902
Name:HANSEN, SUMMER RENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:RENE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:SISNEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 W DOUGLAS
Mailing Address - Street 2:
Mailing Address - City:GUIDE ROCK
Mailing Address - State:NE
Mailing Address - Zip Code:68942-9796
Mailing Address - Country:US
Mailing Address - Phone:402-257-7004
Mailing Address - Fax:
Practice Address - Street 1:3563 PRAIRIEVIEW ST STE 220
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4442
Practice Address - Country:US
Practice Address - Phone:402-257-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist