Provider Demographics
NPI:1356571137
Name:HANSON, SUSHANNAH WYNN (MS SLP-CF)
Entity type:Individual
Prefix:MS
First Name:SUSHANNAH
Middle Name:WYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2334 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3569
Mailing Address - Country:US
Mailing Address - Phone:205-329-9061
Mailing Address - Fax:256-215-3794
Practice Address - Street 1:245 CAHABA VALLEY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2217
Practice Address - Country:US
Practice Address - Phone:205-942-6820
Practice Address - Fax:205-942-5884
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist