Provider Demographics
NPI:1790077055
Name:HANSEN, NATALIE SARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SARA
Last Name:HANSEN
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 1:18171 MANDARIN LN APT A
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3445
Mailing Address - Country:US
Mailing Address - Phone:714-715-3680
Mailing Address - Fax:
Practice Address - Street 1:4444 PLUMOSA DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2322
Practice Address - Country:US
Practice Address - Phone:714-986-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist