Provider Demographics
NPI:1912543075
Name:HANSEN, COURTNEY (BS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FOUNTAIN BROOK CIRCLE
Mailing Address - Street 2:D2
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:914-474-9777
Mailing Address - Fax:
Practice Address - Street 1:103 FOUNTAIN BROOK CIRCLE
Practice Address - Street 2:D2
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:914-474-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC220412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant