Provider Demographics
NPI:1285029355
Name:HANSEN, MICHELLE ALICE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALICE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6616 REED CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-4005
Mailing Address - Country:US
Mailing Address - Phone:720-434-7777
Mailing Address - Fax:720-726-7140
Practice Address - Street 1:6616 REED CT
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-4005
Practice Address - Country:US
Practice Address - Phone:720-434-7777
Practice Address - Fax:720-726-7140
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98734539Medicaid