Provider Demographics
NPI:1467567107
Name:HANSON, PAMELA MARIE (MS CCC/SLP AVT)
Entity Type:Individual
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First Name:PAMELA
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS CCC/SLP AVT
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Mailing Address - Street 1:9420 CALICO GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0164
Mailing Address - Country:US
Mailing Address - Phone:702-215-9382
Mailing Address - Fax:702-341-8365
Practice Address - Street 1:6701 W CHARLESTON BLVD # 26
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-341-8352
Practice Address - Fax:702-341-8365
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVSP-170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402059Medicaid