Provider Demographics
NPI:1518063239
Name:HANSON, CHERYL RAE (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ANITA DR
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-9560
Mailing Address - Country:US
Mailing Address - Phone:417-649-8045
Mailing Address - Fax:
Practice Address - Street 1:100 E VINE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3734
Practice Address - Country:US
Practice Address - Phone:615-890-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist