Provider Demographics
NPI:1275745192
Name:JUDITH HANSEN MS CCC-SLP LLC
Entity Type:Organization
Organization Name:JUDITH HANSEN MS CCC-SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-788-9006
Mailing Address - Street 1:5 WALTER FORAN BLVD
Mailing Address - Street 2:UNIT 2003
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4572
Mailing Address - Country:US
Mailing Address - Phone:908-788-9006
Mailing Address - Fax:908-788-9092
Practice Address - Street 1:5 WALTER FORAN BLVD
Practice Address - Street 2:UNIT 2003
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4572
Practice Address - Country:US
Practice Address - Phone:908-788-9006
Practice Address - Fax:908-788-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYSO1165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty