Provider Demographics
NPI:1710450705
Name:HASAN, ALAA Y (MHS)
Entity Type:Individual
Prefix:MRS
First Name:ALAA
Middle Name:Y
Last Name:HASAN
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 S 78TH CT
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-2334
Mailing Address - Country:US
Mailing Address - Phone:708-612-1032
Mailing Address - Fax:
Practice Address - Street 1:6135 108TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2190
Practice Address - Country:US
Practice Address - Phone:708-636-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist