Provider Demographics
NPI:1558521781
Name:HANSON, ANGIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 21ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1305
Mailing Address - Country:US
Mailing Address - Phone:605-380-3917
Mailing Address - Fax:
Practice Address - Street 1:216 21ST AVE NE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1305
Practice Address - Country:US
Practice Address - Phone:605-380-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD56441-2235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist