Provider Demographics
NPI:1245280684
Name:HANKS, ALISON SHAWN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:SHAWN
Last Name:HANKS
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 1:4825 BAYHERON PLACE, #506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616
Mailing Address - Country:US
Mailing Address - Phone:913-706-9475
Mailing Address - Fax:
Practice Address - Street 1:12220 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9201
Practice Address - Country:US
Practice Address - Phone:813-631-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2158235Z00000X
FLSA 9234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245280684Medicaid