Provider Demographics
NPI:1548415912
Name:HANSEN, HEIDI LEA
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LEA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PRISCILLA LN
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2316
Mailing Address - Country:US
Mailing Address - Phone:914-582-1827
Mailing Address - Fax:
Practice Address - Street 1:47 PRISCILLA LN
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-2316
Practice Address - Country:US
Practice Address - Phone:914-582-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014403-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist