Provider Demographics
NPI:1902198567
Name:HANSEN, JAMIE MARIA (MS CCC/SLP NYLICENSE)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS CCC/SLP NYLICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026-1044
Mailing Address - Country:US
Mailing Address - Phone:716-783-3153
Mailing Address - Fax:
Practice Address - Street 1:5360 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1044
Practice Address - Country:US
Practice Address - Phone:716-783-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010584-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist