Provider Demographics
NPI:1477942274
Name:HANSEN, BROOKE KRISTINE (MA CF SLP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:KRISTINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1209
Mailing Address - Country:US
Mailing Address - Phone:641-521-4046
Mailing Address - Fax:
Practice Address - Street 1:5406 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1209
Practice Address - Country:US
Practice Address - Phone:641-521-4046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist