Provider Demographics
NPI:1962492025
Name:HANSEN, KELLY LYNNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNNE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DEERPATH CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2054
Mailing Address - Country:US
Mailing Address - Phone:727-786-4010
Mailing Address - Fax:727-934-1773
Practice Address - Street 1:8605 EASTHAVEN CT
Practice Address - Street 2:SUITE 101
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5216
Practice Address - Country:US
Practice Address - Phone:727-372-1130
Practice Address - Fax:727-373-1132
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY296231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51460OtherBCBS- UAW