Provider Demographics
NPI:1710152129
Name:HANSON, REBECCA M (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
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 1:201 E 54TH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1202
Mailing Address - Country:US
Mailing Address - Phone:907-301-3396
Mailing Address - Fax:907-561-3522
Practice Address - Street 1:201 E 54TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1202
Practice Address - Country:US
Practice Address - Phone:907-301-3396
Practice Address - Fax:907-561-3522
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP8687Medicaid