Provider Demographics
NPI:1376527994
Name:HANKERSON, JAN C (MS CCCA FAAA)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:C
Last Name:HANKERSON
Suffix:
Gender:F
Credentials:MS CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SE MARLIN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9649
Mailing Address - Country:US
Mailing Address - Phone:503-861-3235
Mailing Address - Fax:503-861-3436
Practice Address - Street 1:429 SE MARLIN AVE
Practice Address - Street 2:STE A
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9649
Practice Address - Country:US
Practice Address - Phone:503-861-3235
Practice Address - Fax:503-861-3235
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP584193237700000X
OR20434231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR018999Medicaid
OR000DVGBHGMedicare ID - Type Unspecified
OR018999Medicaid