Provider Demographics
NPI:1568584365
Name:HANSON, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HANSON
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 1:1111 EXPOSITION BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4300
Mailing Address - Country:US
Mailing Address - Phone:916-736-3408
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1111 EXPOSITION BLVD STE 700
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4300
Practice Address - Country:US
Practice Address - Phone:916-736-3408
Practice Address - Fax:916-233-4171
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07316ZMedicare PIN