Provider Demographics
NPI:1295900066
Name:HANSEN, JAMES E (MS CCC-A/SLP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MS CCC-A/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W532 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-2902
Mailing Address - Country:US
Mailing Address - Phone:262-763-9061
Mailing Address - Fax:
Practice Address - Street 1:W532 POTTER RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-2902
Practice Address - Country:US
Practice Address - Phone:262-763-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist