Provider Demographics
NPI:1982671418
Name:HASSANI, AUDREY LYN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LYN
Last Name:HASSANI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 FAIRFIELD ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-1430
Mailing Address - Fax:208-734-0588
Practice Address - Street 1:440 FAIRFIELD ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-1430
Practice Address - Fax:208-734-0588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01026589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010007166OtherREGENCE BLUE SHIELD
IDSPC83OtherBLUE CROSS OF ID
ID136531Medicare ID - Type Unspecified