Provider Demographics
NPI:1518130012
Name:HANSEN, KIM LAMBERT (MNS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LAMBERT
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MNS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6280
Mailing Address - Country:US
Mailing Address - Phone:480-273-8510
Mailing Address - Fax:480-214-9933
Practice Address - Street 1:926 E MCDOWELL RD STE 208
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2508
Practice Address - Country:US
Practice Address - Phone:602-257-4228
Practice Address - Fax:602-252-6416
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1376231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDA1376OtherAZ DEPARTMENT OF HEALTH SERVICES