Provider Demographics
NPI:1427192483
Name:HANSEN WHITSON, SALLY (MS CCCA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HANSEN WHITSON
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:HANSEN WHITSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCCA
Mailing Address - Street 1:10 ELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6460
Mailing Address - Country:US
Mailing Address - Phone:262-853-0771
Mailing Address - Fax:864-331-1416
Practice Address - Street 1:29 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:864-331-1400
Practice Address - Fax:864-331-1416
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3438231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist